Provider Demographics
NPI:1407010101
Name:ARISS, MICHELLE MIRNA (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MIRNA
Last Name:ARISS
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 1:5700 MONROE ST UNIT 211
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2737
Mailing Address - Country:US
Mailing Address - Phone:419-776-1004
Mailing Address - Fax:419-776-1020
Practice Address - Street 1:5700 MONROE ST UNIT 211
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-776-1004
Practice Address - Fax:419-776-1020
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35739207W00000X
MO2012018683207W00000X
OH35092138207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2016160Medicaid