Healthcare Provider Details

I. General information

NPI: 1174787972
Provider Name (Legal Business Name): MANAF ZAIZAFOUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD STE 109
LORAIN OH
44053-1652
US

IV. Provider business mailing address

3600 KOLBE RD STE 109
LORAIN OH
44053-1652
US

V. Phone/Fax

Practice location:
  • Phone: 440-960-6431
  • Fax: 440-960-6435
Mailing address:
  • Phone: 440-960-6431
  • Fax: 440-960-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50589
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.125787
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: