Provider Demographics
NPI:1003802695
Name:MIGALLY, NABIL B (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:B
Last Name:MIGALLY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 BRANDT PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6137
Mailing Address - Country:US
Mailing Address - Phone:937-233-0748
Mailing Address - Fax:937-233-6086
Practice Address - Street 1:5212 BRANDT PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-6137
Practice Address - Country:US
Practice Address - Phone:937-233-0748
Practice Address - Fax:937-233-6086
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058434M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000011383OtherANTHEM PIN-L
OH0685048OtherPTAN
OH0685041OtherPTAN
OH0685045OtherPTAN
OH000000011382OtherANTHEM PIN-C
OH000000269197OtherANTHEM PIN-H
OH0690832OtherPTAN
OH0685049OtherPTAN
OH000000011383OtherANTHEM PIN-L
OH0690832OtherPTAN