Individual
DR. MOHAMMAD REZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20455 LORAIN RD, SUITE T04, FAIRVIEW PARK, OH 44126-3494
(440) 333-5767
(440) 333-5768
Mailing address
PO BOX 450923, WESTLAKE, OH 44145-0621
(444) 333-5767
(440) 333-5768
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-076235
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000333406
ANTHEM
OH
01
—
04 06811
EVERCARE
OH
05
—
2177522
—
OH
01
—
300230243026
CARESOURCE
OH
05
—
3810004119
—
WV
01
—
91894
QUALCHOICE
OH
01
—
F76235
SUMMACARE
OH
Enumeration date
03/29/2006
Last updated
07/09/2021
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