Provider Demographics
NPI:1780777219
Name:SEYED MIRFENDERESKI, MD, LLC
Entity type:Organization
Organization Name:SEYED MIRFENDERESKI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-743-2250
Mailing Address - Street 1:P.O. BOX 545
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022
Mailing Address - Country:US
Mailing Address - Phone:440-743-2250
Mailing Address - Fax:440-834-1902
Practice Address - Street 1:6681 RIDGE RD
Practice Address - Street 2:407
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5713
Practice Address - Country:US
Practice Address - Phone:440-743-2250
Practice Address - Fax:440-834-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072710M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2446651Medicaid
OH9363801Medicare PIN