Provider Demographics
NPI:1083644850
Name:ESLAMI, JALEH (MD)
Entity Type:Individual
Prefix:DR
First Name:JALEH
Middle Name:
Last Name:ESLAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3660
Mailing Address - Country:US
Mailing Address - Phone:937-914-7044
Mailing Address - Fax:937-522-7595
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 4300
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-395-8454
Practice Address - Fax:937-395-8774
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091028208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2823065Medicaid
OH4228841Medicare PIN