Provider Demographics
NPI:1396800645
Name:YOUSSEFI, MOJTABA E (MD)
Entity type:Individual
Prefix:
First Name:MOJTABA
Middle Name:E
Last Name:YOUSSEFI
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 1:7255 OLD OAK BLVD STE C408
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3331
Mailing Address - Country:US
Mailing Address - Phone:440-414-9500
Mailing Address - Fax:216-201-5590
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:SUITE C408
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-414-9500
Practice Address - Fax:216-201-5590
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060581207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0127919Medicaid
OHG13325Medicare UPIN
OHY00775254Medicare PIN