Provider Demographics
NPI:1922051937
Name:NUKTA, EMAD DEAN (MD)
Entity Type:Individual
Prefix:
First Name:EMAD
Middle Name:DEAN
Last Name:NUKTA
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 1:20455 LORAIN RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-333-8600
Mailing Address - Fax:440-333-5015
Practice Address - Street 1:20455 LORAIN RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3494
Practice Address - Country:US
Practice Address - Phone:440-333-8600
Practice Address - Fax:440-333-5015
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052766207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0762750Medicaid
OHE23026Medicare UPIN
OH0762750Medicaid