Healthcare Provider Details

I. General information

NPI: 1659876308
Provider Name (Legal Business Name): MUNEEB AKBAR ILYAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 RIDGE ROAD SUITE #204
PARMA OH
44129-5647
US

IV. Provider business mailing address

2000 AUBURN DR. STE. 350
BEACHWOOD OH
44122-4327
US

V. Phone/Fax

Practice location:
  • Phone: 440-845-1146
  • Fax: 440-845-4023
Mailing address:
  • Phone: 440-646-1600
  • Fax: 440-646-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0102207757
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34.017077
License Number StateOH
# 3
Primary TaxonomyN
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: