Healthcare Provider Details

I. General information

NPI: 1295239861
Provider Name (Legal Business Name): MUNIRAH BOMANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 THE GRN # 16016
DOVER DE
19901-3618
US

IV. Provider business mailing address

3483 W 145TH ST
CLEVELAND OH
44111-2206
US

V. Phone/Fax

Practice location:
  • Phone: 302-603-1005
  • Fax: 302-546-5700
Mailing address:
  • Phone: 216-647-8259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.166476
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0028069
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.142175
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: