Healthcare Provider Details

I. General information

NPI: 1124730874
Provider Name (Legal Business Name): ISRA IDRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQUARE, AKRON, OHIO 44308
AKRON OH
44308
US

IV. Provider business mailing address

3800 WOODWARD AVE APT 306
DETROIT MI
48201-1978
US

V. Phone/Fax

Practice location:
  • Phone: 571-484-2860
  • Fax:
Mailing address:
  • Phone: 571-484-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35.155752
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: