Healthcare Provider Details

I. General information

NPI: 1326238304
Provider Name (Legal Business Name): MARVIN SIY SIH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6847 N CHESTNUT ST STE 325
RAVENNA OH
44266-3929
US

IV. Provider business mailing address

8055 MAYFIELD RD STE 105
CHESTERLAND OH
44026-2447
US

V. Phone/Fax

Practice location:
  • Phone: 330-297-2401
  • Fax: 330-297-4485
Mailing address:
  • Phone: 440-214-8027
  • Fax: 216-201-8173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number04-36211
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number04-36211
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.134347
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: