Healthcare Provider Details

I. General information

NPI: 1851913735
Provider Name (Legal Business Name): YAHYA AZHAR OTHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date: 01/11/2022
Reactivation Date: 04/08/2022

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number332722
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: