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General NPI Number Information
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NPI Number | 1720049810
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Entity Type | Individual
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Provider Name | MOHAMMAD REZA MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 20455 LORAIN RD SUITE T04
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-3494
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Country | US
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Telephone | 440-333-5767
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Fax | 440-333-5768
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Provider Business Mailing Address
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Address Line | PO BOX 450923
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City | WESTLAKE
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State | OH
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Zip | 44145-0621
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Country | US
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Telephone | 444-333-5767
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Fax | 440-333-5768
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35-076235
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License Number State | OH
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