Individual
DR. MORTEZA MIRHAIDARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM, MD
Contact information
Practice address
152 N BROADWAY ST, SUITE 100, NEW PHILADELPHIA, OH 44663-2665
(330) 364-8884
(330) 440-7038
Mailing address
152 N BROADWAY ST, SUITE 100, NEW PHILADELPHIA, OH 44663-2665
(330) 364-8884
(330) 602-5747
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
36.002348
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0624793
—
OH
01
—
480005452
RAILROAD MEDICARE
OH
Enumeration date
08/08/2006
Last updated
12/18/2012
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