Healthcare Provider Details

I. General information

NPI: 1356971428
Provider Name (Legal Business Name): EMAN FEKRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 CHESTER AVE
CLEVELAND OH
44106-1666
US

IV. Provider business mailing address

35715 MICHAEL DR
SOLON OH
44139-5673
US

V. Phone/Fax

Practice location:
  • Phone: 630-765-1852
  • Fax:
Mailing address:
  • Phone: 630-765-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberRES.004173
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number30027073
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: