Provider Demographics
NPI:1578556890
Name:ODEH, NEIMAN TOUFEK (DO)
Entity Type:Individual
Prefix:DR
First Name:NEIMAN
Middle Name:TOUFEK
Last Name:ODEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-502-3537
Practice Address - Street 1:22614 W STATE ROUTE 51
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:OH
Practice Address - Zip Code:43430-1143
Practice Address - Country:US
Practice Address - Phone:419-855-7772
Practice Address - Fax:419-855-4800
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.005838207P00000X
OH34005838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0178650Medicaid
OH0178650Medicaid