Basic Information
| Provider Information | |||||||||
| NPI: | 1629163621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISRAELI | ||||||||
| FirstName: | RAFI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3605 WARRENSVILLE CENTER ROAD | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | SHAKER HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162866260 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168441000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 237813 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 237813 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 35.090007 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000225737 | 01 | OH | UNISON | OTHER | 9896058 | 01 | OH | AETNA | OTHER | 750787 | 01 | OH | BUCKEYE MEDICAID | OTHER | 2761962 | 05 | OH | MEDICAID | 0000000532678 | 01 | OH | ANTHEM | OTHER | 410534 | 01 | OH | WELLCARE | OTHER | P00432285 | 01 | OH | RAILROAD MEDICARE | OTHER |