Provider Demographics
NPI:1881727766
Name:SUBAN M RAZACK M D INC
Entity type:Organization
Organization Name:SUBAN M RAZACK M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBAN
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:RAZACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-724-1215
Mailing Address - Street 1:1134 BROWN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-1964
Mailing Address - Country:US
Mailing Address - Phone:330-724-1215
Mailing Address - Fax:
Practice Address - Street 1:1134 BROWN ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-1964
Practice Address - Country:US
Practice Address - Phone:330-724-1215
Practice Address - Fax:330-724-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2746603Medicaid
OHDB8650Medicare PIN
OH2746603Medicaid