Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35.136541 | OH |
NPI | 1033504501 |
---|---|
Provider Name | Rachel Mistur |
First Address | Beachwood, OH 44122-4329 |
Second Address | Beachwood, OH 44122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 16/06/2021 |