Healthcare Provider Details

I. General information

NPI: 1336535616
Provider Name (Legal Business Name): MARK MEKHAIL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29800 BAINBRIDGE RD
SOLON OH
44139
US

IV. Provider business mailing address

29800 BAINBRIDGE RD
SOLON OH
44139-2202
US

V. Phone/Fax

Practice location:
  • Phone: 440-519-6800
  • Fax:
Mailing address:
  • Phone: 440-519-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34013351
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: