Provider Demographics
NPI:1578739405
Name:AKKAD, WAFA (MD)
Entity Type:Individual
Prefix:
First Name:WAFA
Middle Name:
Last Name:AKKAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 HAMILTON MASON RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8556
Mailing Address - Country:US
Mailing Address - Phone:513-863-6222
Mailing Address - Fax:513-863-6478
Practice Address - Street 1:3145 HAMILTON MASON RD STE 200A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-8556
Practice Address - Country:US
Practice Address - Phone:513-863-6222
Practice Address - Fax:513-863-6478
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.133092207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0298758Medicaid