Provider Demographics
NPI:1760574982
Name:MEHLE, MARK EMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EMIL
Last Name:MEHLE
Suffix:
Gender:M
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:PO BOX 638269
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8269
Mailing Address - Country:US
Mailing Address - Phone:440-816-5091
Mailing Address - Fax:
Practice Address - Street 1:15299 BAGLEY RD STE 300
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4809
Practice Address - Country:US
Practice Address - Phone:440-816-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061857M207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0910465Medicaid
OH040005741OtherMEDICARE RAILROAD
F28025Medicare UPIN
OH040005741OtherMEDICARE RAILROAD