Provider Demographics
NPI:1841260189
Name:SHEMISA, OTHMAN ALY (MD)
Entity type:Individual
Prefix:DR
First Name:OTHMAN
Middle Name:ALY
Last Name:SHEMISA
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 1:26908 COOK RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3548
Mailing Address - Country:US
Mailing Address - Phone:440-414-9700
Mailing Address - Fax:440-235-1045
Practice Address - Street 1:26908 COOK RD
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-3548
Practice Address - Country:US
Practice Address - Phone:440-414-9700
Practice Address - Fax:440-235-1045
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0636271Medicaid
OHF53948OtherSUMMA
OH000000128725OtherANTHEM
080144328OtherRAILROAD MEDICARE
OHF53948OtherSUMMA
OH0636271Medicaid