Provider Demographics
NPI:1689841363
Name:MASADEH, SUHAIL (DPM)
Entity Type:Individual
Prefix:
First Name:SUHAIL
Middle Name:
Last Name:MASADEH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 ALBERT SABIN WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0513
Mailing Address - Country:US
Mailing Address - Phone:513-245-3600
Mailing Address - Fax:
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-558-3668
Practice Address - Fax:513-558-5036
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003453213E00000X
IN07001059A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200911030Medicaid
IN200911030Medicaid
IN151560C9Medicare PIN