Provider Demographics
NPI:1437511680
Name:ISSA, MOHAMAD RAED (MD, MSCR)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:RAED
Last Name:ISSA
Suffix:
Gender:M
Credentials:MD, MSCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5700 MONROE ST UNIT 310
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2768
Practice Address - Country:US
Practice Address - Phone:419-578-7555
Practice Address - Fax:419-539-6336
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPPLYING207Y00000X
OH35.146306207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology