Provider Demographics
NPI:1013092147
Name:YONAN, SAMEH R (MD)
Entity Type:Individual
Prefix:
First Name:SAMEH
Middle Name:R
Last Name:YONAN
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 1:4804 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2382
Mailing Address - Country:US
Mailing Address - Phone:440-989-2066
Mailing Address - Fax:440-989-1153
Practice Address - Street 1:4804 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2382
Practice Address - Country:US
Practice Address - Phone:440-989-2066
Practice Address - Fax:440-989-1153
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084393207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2600797Medicaid
OHI33729Medicare UPIN
OH2600797Medicaid