Provider Demographics
NPI:1295239861
Name:BOMANI, MUNIRAH (MD)
Entity type:Individual
Prefix:
First Name:MUNIRAH
Middle Name:
Last Name:BOMANI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 W 145TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2206
Mailing Address - Country:US
Mailing Address - Phone:216-647-8259
Mailing Address - Fax:
Practice Address - Street 1:8 THE GRN # 16016
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3618
Practice Address - Country:US
Practice Address - Phone:302-603-1005
Practice Address - Fax:302-546-5700
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.166476207Q00000X
DEC1-0028069207Q00000X
OH35.142175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine