Basic Information
| Provider Information | |||||||||
| NPI: | 1992791388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIGALLY | ||||||||
| FirstName: | MAGDY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5212 BRANDT PIKE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HUBER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454246138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372330748 | ||||||||
| FaxNumber: | 9372336086 | ||||||||
| Practice Location | |||||||||
| Address1: | 5212 BRANDT PIKE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HUBER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454246138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372330748 | ||||||||
| FaxNumber: | 9372336086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 10/05/2009 | ||||||||
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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 | 207N00000X | 35-04-3565-M | OH | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 000000066851 | 01 | OH | ANTHEM PIN-L | OTHER | 0470022 | 01 | OH | PTAN | OTHER | 0470024 | 01 | OH | PTAN | OTHER | 000000011390 | 01 | OH | ANTHEM PIN-C | OTHER | 0470029 | 01 | OH | PTAN | OTHER | 0735331 | 01 | OH | PTAN | OTHER | 000000011389 | 01 | OH | ANTHEM PIN-U | OTHER |