MEDICARE: DR. MEHRUNISSA KAISER ANIS MD

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
1	390200000X	Student in an Organized Health Care Education/Training Program		PA
2	207Q00000X	Family Medicine Physician	35.152111	OH

General Provider Information

NPI Number	:	1679156681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEHRUNISSA KAISER ANIS MD

Provider Business Mailing Address
First Line	:	5595 TRANSPORTATION BLVD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5379
Country	:	US
Telephone Number	:	216-518-4633
Fax Number	:

Provider Business Practice Location Address
First Line	:	5595 TRANSPORTATION BLVD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5379
Country	:	US
Telephone Number	:	216-518-4633
Fax Number	:	724-324-9005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	10/28/2024

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