Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35040140 | OH |
Y | 111NI0900X | Internist | 35040140 | OH |
N | 207RA0401X | Internist - Addiction Medicine | 35040140 | OH |
NPI | 1164499158 |
---|---|
Provider Name | Mohamed Nisar |
First Address | Cleveland, OH 44102-5444 |
Second Address | Cleveland, OH 44102-5444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 13/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (02) | |
PENDING | (05) | OH |