Healthcare Provider Details

I. General information

NPI: 1710876453
Provider Name (Legal Business Name): MAKSAT IDRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MAKSAT IDRIS UULU MD

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

1010 EUCLID AVE APT 609V
CLEVELAND OH
44115-1516
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 323-356-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: