Provider Demographics
NPI:1780676981
Name:ORFAHLI, M NIZAR (MD)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:NIZAR
Last Name:ORFAHLI
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 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2551
Practice Address - Country:US
Practice Address - Phone:419-238-5864
Practice Address - Fax:419-238-8800
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074233207RC0200X, 207RP1001X
OH35062579O207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000896491OtherBCBS
IN201243860Medicaid
OH0939640Medicaid
IN201243860Medicaid
IN187670007Medicare PIN
OHOR0749244Medicare ID - Type Unspecified