Basic Information
Provider Information
NPI: 1003004128
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAZAVI
FirstName: AMIR
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1700 E 13TH ST
Address2: APT. E15K
City: CLEVELAND
State: OH
PostalCode: 441143241
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2500 METROHEALTH DR
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441091900
CountryCode: US
TelephoneNumber: 2167787800
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/15/2007
LastUpdateDate: 10/15/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X57012922OHY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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