Basic Information
| Provider Information | |||||||||
| NPI: | 1255674263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELRAMAHI | ||||||||
| FirstName: | WESAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6939 COX RD STE 360 | ||||||||
| Address2: | |||||||||
| City: | LIBERTY TOWNSHIP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450697595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135646800 | ||||||||
| FaxNumber: | 5135646815 | ||||||||
| Practice Location | |||||||||
| Address1: | 2160 S 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | MAYWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601533328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082169000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 49191 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35.140908 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036151161 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100307290 | 05 | KY | MEDICAID | 0425661 | 05 | OH | MEDICAID |