Provider Demographics
NPI:1467679589
Name:RAWAL, ISH (MD)
Entity Type:Individual
Prefix:
First Name:ISH
Middle Name:
Last Name:RAWAL
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 1:1455 HARRISON AVE NW
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2621
Mailing Address - Country:US
Mailing Address - Phone:330-956-5236
Mailing Address - Fax:330-956-5345
Practice Address - Street 1:1455 HARRISON AVE NW
Practice Address - Street 2:SUITE 207
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2621
Practice Address - Country:US
Practice Address - Phone:330-956-5236
Practice Address - Fax:330-956-5345
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088985207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist