Provider Demographics
NPI:1144213380
Name:RASLAN, FARES (MD)
Entity Type:Individual
Prefix:DR
First Name:FARES
Middle Name:
Last Name:RASLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25200 CENTER RIDGE RD
Mailing Address - Street 2:SUITE #3100
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4141
Mailing Address - Country:US
Mailing Address - Phone:440-331-4559
Mailing Address - Fax:440-331-4843
Practice Address - Street 1:25200 CENTER RIDGE RD
Practice Address - Street 2:SUITE #3100
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4141
Practice Address - Country:US
Practice Address - Phone:440-331-4559
Practice Address - Fax:440-331-4843
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2014-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-067207207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0131566Medicaid
OH050074523OtherRAILROAD MEDICARE
OH000000142267OtherANTHEM BCBS
OH341924447030OtherCARESOURCE
OH050074523OtherRAILROAD MEDICARE
OHF97528Medicare UPIN