Provider Demographics
NPI:1407835713
Name:NICOLA, SAMI F (MD)
Entity Type:Individual
Prefix:
First Name:SAMI
Middle Name:F
Last Name:NICOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMI-FOUAD
Other - Middle Name:ISKANDER
Other - Last Name:NICOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 74647
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0730
Mailing Address - Country:US
Mailing Address - Phone:440-879-0081
Mailing Address - Fax:440-879-0084
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2203
Practice Address - Country:US
Practice Address - Phone:440-449-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-100178207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0310176Medicaid
OH000000325656OtherANTHEM
C03137Medicare UPIN
OH000000325656OtherANTHEM