Healthcare Provider Details

I. General information

NPI: 1316977663
Provider Name (Legal Business Name): ADNAN H TAHIR-FADLALLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4758 RIDGE RD #161
CLEVELAND OH
44144-3327
US

IV. Provider business mailing address

2322 E 22ND ST SUITE 200
CLEVELAND OH
44115-3176
US

V. Phone/Fax

Practice location:
  • Phone: 440-236-8484
  • Fax:
Mailing address:
  • Phone: 216-363-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35057864-T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: