Provider Demographics
NPI:1801880471
Name:DOUMET, MAHDI NICOLA (MD)
Entity type:Individual
Prefix:
First Name:MAHDI
Middle Name:NICOLA
Last Name:DOUMET
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 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:6855 SPRING VALLEY DR
Practice Address - Street 2:#120
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8039
Practice Address - Country:US
Practice Address - Phone:419-865-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.067558207RA0401X
OH35067558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101348Medicaid
OH0101348Medicaid
OH89246Medicare UPIN