Healthcare Provider Details

I. General information

NPI: 1912958810
Provider Name (Legal Business Name): TOM RIFAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # F20
CLEVELAND OH
44195-5031
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR STE L-4000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-6568
  • Fax: 248-445-1656
Mailing address:
  • Phone: 248-845-2120
  • Fax: 248-282-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number4301076062
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301076062
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: