MEDICARE: SUMMIT NEUROENDOVASCULAR SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician
2	2085N0700X	Neuroradiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841739257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT NEUROENDOVASCULAR SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	3867 MEDINA RD # 270
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-4525
Country	:	US
Telephone Number	:	330-344-2387
Fax Number	:	330-344-6344

Provider Business Practice Location Address
First Line	:	3867 MEDINA RD # 270
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-4525
Country	:	US
Telephone Number	:	330-344-2387
Fax Number	:	330-344-6344

Authorized Official
Title or Position	:	OWNER
Name	:	FIRAS AL-ALI
Credential	:
Telephone Number	:	330-344-2387

Provider Enumeration Date	:	02/17/2017
Last Update Date	:	10/19/2023

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