Healthcare Provider Details

I. General information

NPI: 1619236353
Provider Name (Legal Business Name): AHMAD MUSTAFA AMIREH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 DARROW RD SUITE 106
HUDSON OH
44236-5026
US

IV. Provider business mailing address

3550 5TH AVE
YOUNGSTOWN OH
44505-1908
US

V. Phone/Fax

Practice location:
  • Phone: 330-656-5911
  • Fax:
Mailing address:
  • Phone: 330-941-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.124363
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: