Provider Demographics
NPI:1265417117
Name:MAROUF, MOHAMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:MAROUF
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27100 CHARDON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1116
Practice Address - Country:US
Practice Address - Phone:440-585-6500
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075251M207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2225167Medicaid
OH7858192OtherAETNA
OH415007OtherWELLCARE
OHP00432291OtherRAILROAD MEDICARE
OHBUCKEYEOther732690
OH000000538199OtherANTHEM
OH000000381220OtherANTHEM
MI1265417117Medicaid
OH000000221291OtherUNISON
OH000000538199OtherANTHEM
OH2225167Medicaid
OHMA0886479Medicare PIN
OH000000381220OtherANTHEM