Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 01072711A | IN |
N | 207RR0500X | Rheumatology | 35085724 | OH |
Y | 207RR0500X | Rheumatology | 52243 | KY |
NPI | 1104978048 |
---|---|
Provider Name | Mazen Elyan |
First Address | Cincinnati, OH 45263-5283 |
Second Address | Crestview Hills, KY 41017-5419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 26/04/2019 |