Healthcare Provider Details

I. General information

NPI: 1669956058
Provider Name (Legal Business Name): MARYEM MENAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 CORPORATE WAY STE 212
MASON OH
45040-9560
US

IV. Provider business mailing address

231 OAK ST APT 307
CINCINNATI OH
45219-2389
US

V. Phone/Fax

Practice location:
  • Phone: 877-938-6537
  • Fax:
Mailing address:
  • Phone: 614-649-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number3821
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: