Healthcare Provider Details

I. General information

NPI: 1689606006
Provider Name (Legal Business Name): AMITABH GOEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/07/2020
Certification Date: 11/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 W MAIN ST # 201
GENEVA OH
44041-1219
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-1141
  • Fax: 440-416-0390
Mailing address:
  • Phone: 440-415-0115
  • Fax: 440-415-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-075221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: