Healthcare Provider Details

I. General information

NPI: 1255836409
Provider Name (Legal Business Name): RIM SOLIMAN ISHAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5172 LEAVITT RD
LORAIN OH
44053-2384
US

IV. Provider business mailing address

5172 LEAVITT RD
LORAIN OH
44053-2384
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-7420
  • Fax: 440-204-7376
Mailing address:
  • Phone: 440-282-7420
  • Fax: 440-204-7376

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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.148331
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number35.148331
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number4351038200
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: