Provider Demographics
NPI:1023125937
Name:RIAD, KAMAL SODI (MD)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:SODI
Last Name:RIAD
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 1:12895 LASER DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-3046
Mailing Address - Country:US
Mailing Address - Phone:440-943-2500
Mailing Address - Fax:440-951-9408
Practice Address - Street 1:2550 SOM CENTER ROAD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-943-2500
Practice Address - Fax:440-516-8666
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH079718R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38386Medicare UPIN
OHRI4052006Medicare ID - Type Unspecified