Healthcare Provider Details

I. General information

NPI: 1003660366
Provider Name (Legal Business Name): SAFWAN TAYEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2042 E 102ND ST
CLEVELAND OH
44106-2120
US

IV. Provider business mailing address

3103-55 GERRARD ST W
TORONTO ZZ - FOREIGN COUNTRIES
M5G0B9
CA

V. Phone/Fax

Practice location:
  • Phone: 216-444-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.150342
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: