Provider Demographics
NPI:1518195478
Name:INTEGRATED HEALTH SERVICES MANAGEMENT
Entity Type:Organization
Organization Name:INTEGRATED HEALTH SERVICES MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANSOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-239-7533
Mailing Address - Street 1:17900 JEFFERSON PARK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3437
Mailing Address - Country:US
Mailing Address - Phone:440-239-7533
Mailing Address - Fax:440-239-2585
Practice Address - Street 1:6820 RIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5647
Practice Address - Country:US
Practice Address - Phone:440-239-7533
Practice Address - Fax:440-239-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064077207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO9638Medicare PIN