Basic Information
Provider Information
NPI: 1003802695
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MIGALLY
FirstName: NABIL
MiddleName: B
NamePrefix: DR.
NameSuffix:  
Credential: MD PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5212 BRANDT PIKE
Address2: SUITE A
City: HUBER HEIGHTS
State: OH
PostalCode: 454246137
CountryCode: US
TelephoneNumber: 9372330748
FaxNumber: 9372336086
Practice Location
Address1: 5212 BRANDT PIKE
Address2: SUITE A
City: HUBER HEIGHTS
State: OH
PostalCode: 454246137
CountryCode: US
TelephoneNumber: 9372330748
FaxNumber: 9372336086
Other Information
ProviderEnumerationDate: 09/20/2005
LastUpdateDate: 10/05/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X35058434MOHY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
068504501OHPTANOTHER
068504801OHPTANOTHER
00000001138201OHANTHEM PIN-COTHER
00000001138301OHANTHEM PIN-LOTHER
068504101OHPTANOTHER
069083201OHPTANOTHER
00000026919701OHANTHEM PIN-HOTHER
068504901OHPTANOTHER


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