Provider Demographics
NPI:1659358950
Name:SAGHAFI, KOUROSH
Entity Type:Individual
Prefix:
First Name:KOUROSH
Middle Name:
Last Name:SAGHAFI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6681 RIDGE ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5713
Mailing Address - Country:US
Mailing Address - Phone:440-842-8675
Mailing Address - Fax:440-842-1299
Practice Address - Street 1:6681 RIDGE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5713
Practice Address - Country:US
Practice Address - Phone:440-842-8675
Practice Address - Fax:440-842-1299
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006341207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0255585Medicaid
OHG34812Medicare UPIN
OH4132641Medicare PIN