Provider Demographics
NPI:1295702355
Name:KALASH, MOHAMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:KALASH
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 1:24651 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5635
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:15644 MADISON AVE
Practice Address - Street 2:STE 101
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-228-6565
Practice Address - Fax:216-221-5173
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000030587OtherANTHEM
0657195OtherAETNA
103016OtherKAISER
110131715OtherRR MEDICARE INDIVIDUAL
3610861OtherGROUP ASC MEDICARE
9273172OtherGROUP MEDICARE
0119204OtherGROUP MEDICAID
CA4511OtherGROUP RR MEDICARE
OH0852402Medicaid
341783789043OtherCARESOURCE
D368301OtherGROUP IND DIAGNOSTICS MED
F61572OtherSUMMACARE APEX
10821371OtherCAQH
CA4511OtherRR MEDICARE GROUP
1780634279OtherGROUP NPI
D368301OtherGROUP IND DIAGNOSTICS MED
E93273Medicare UPIN
OH0852402Medicaid