Provider Demographics
NPI:1407022940
Name:MAMOUN, IHSAN IRFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IHSAN
Middle Name:IRFAN
Last Name:MAMOUN
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 1:9500 EUCLID AVE.
Mailing Address - Street 2:CLEVELAND CLINIC RADIOLOGY RESIDENCEY OFFICE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:216-444-9544
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE.
Practice Address - Street 2:CLEVELAND CLINIC RADIOLOGY RESIDENCEY OFFICE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0945362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology