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Organization

NORTHEAST OHIO PRACTITIONER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KOUROSH SAGHAFI DO (PRESIDENT)
(216) 842-8675
Entity
Organization

Contact information

Practice address
6681 RIDGE RD STE 300, PARMA, OH 44129-5705
(440) 842-8675
(440) 842-1299
Mailing address
6681 RIDGE RD STE 300, PARMA, OH 44129-5705
(440) 842-8675
(440) 842-1299

Taxonomy

Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
4171215
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4171215
BUSINESS LICENSE
OH
Enumeration date
06/04/2018
Last updated
03/13/2019
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