Individual
DIYA F. MUTASIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
222 PIEDMONT AVE, CINCINNATI, OH 45219-4231
(513) 475-7630
(513) 475-7636
Mailing address
222 PIEDMONT AVE, CINCINNATI, OH 45219-4231
(513) 475-7630
(513) 475-7636
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
35.059745
OH
207ND0900X
Dermatopathology Physician
Primary
35.059745
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070004743
RR MEDICARE
OH
05
—
0781882
—
OH
05
—
200038080A
—
IN
05
—
64869787
—
KY
Enumeration date
05/20/2006
Last updated
01/08/2014
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