Healthcare Provider Details

I. General information

NPI: 1477517183
Provider Name (Legal Business Name): RISAL S DJOHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

6000 W CREEK RD SUITE 10
INDEPENDENCE OH
44131-2139
US

V. Phone/Fax

Practice location:
  • Phone: 800-223-2273
  • Fax:
Mailing address:
  • Phone: 800-223-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35083499D
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number264225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: