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NPI Code Detail

MEDICARE: DR. NANA KOBAIVANOVA M.D.

MEDICARE: DR. NANA KOBAIVANOVA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician35081513OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447208640
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANA KOBAIVANOVA M.D.
Provider Business Mailing Address
First Line : 13944 EUCLID AVE
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44112-3804
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13944 EUCLID AVE
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44112-3804
Country : US
Telephone Number : 216-767-4242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 10/10/2021

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