Healthcare Provider Details

I. General information

NPI: 1649953647
Provider Name (Legal Business Name): RYAN MOHAMMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13719 LORAIN AVE
CLEVELAND OH
44111-3439
US

IV. Provider business mailing address

6061 FATHER CARUSO DR APT 3308
CLEVELAND OH
44102-2180
US

V. Phone/Fax

Practice location:
  • Phone: 216-307-3005
  • Fax:
Mailing address:
  • Phone: 929-632-5312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.155822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: