Healthcare Provider Details

I. General information

NPI: 1972491751
Provider Name (Legal Business Name): RIADH CHEDDADI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 JEFFERSON AVE
TOLEDO OH
43604-7101
US

IV. Provider business mailing address

2213 CHERRY ST
TOLEDO OH
43608-2603
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-1400
  • Fax: 419-251-1797
Mailing address:
  • Phone: 419-251-6596
  • Fax: 419-251-2698

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 StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2025025714
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: