Healthcare Provider Details

I. General information

NPI: 1013932102
Provider Name (Legal Business Name): KAMAL-NEIL S DASS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR MHMC-PSYCHIATRY
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR MHMC-PSYCHIATRY
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-3745
  • Fax:
Mailing address:
  • Phone: 216-778-3745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number34007339
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: