Healthcare Provider Details

I. General information

NPI: 1821839234
Provider Name (Legal Business Name): MUHANNED ASSAF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5735 MEEKER RD
GREENVILLE OH
45331-1180
US

IV. Provider business mailing address

5431 W 83RD ST
BURBANK IL
60459-2067
US

V. Phone/Fax

Practice location:
  • Phone: 937-547-2326
  • Fax:
Mailing address:
  • Phone:
  • 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: