=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518016302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL K MENYAH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 SEVERANCE CIR SUITE 709
-----------------------------------------------------
City | CLEVELAND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-1566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-291-0515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2351 E 22ND ST
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44115-3111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-291-0515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 35-041938
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------