Healthcare Provider Details

I. General information

NPI: 1831114537
Provider Name (Legal Business Name): EMOLYN M DEFENSOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WEST MAIN ST SYED A HYSSAINI MD INC
GENEVA OH
44041
US

IV. Provider business mailing address

810 WEST MAIN ST
GENEVA OH
44041
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-5889
  • Fax: 440-466-5889
Mailing address:
  • Phone: 440-466-5889
  • Fax: 440-466-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35043658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: