Healthcare Provider Details

I. General information

NPI: 1275638199
Provider Name (Legal Business Name): SAMIR ABRAKSIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WARRENSVILLE CENTER RD
BEACHWOOD OH
44122-7051
US

IV. Provider business mailing address

2732 SINTON PL
PEPPER PIKE OH
44124-4630
US

V. Phone/Fax

Practice location:
  • Phone: 216-491-6438
  • Fax: 330-562-9417
Mailing address:
  • Phone: 216-595-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35061538
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: