Provider Demographics
NPI:1982705851
Name:ESRAEILIAN, SINA BENJAMIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SINA
Middle Name:BENJAMIN
Last Name:ESRAEILIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23485 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1448
Mailing Address - Country:US
Mailing Address - Phone:440-585-1616
Mailing Address - Fax:
Practice Address - Street 1:1491 LLOYD RD
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2319
Practice Address - Country:US
Practice Address - Phone:440-585-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002709213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882540Medicaid
OH34-1724510-002OtherMEDICAL MUTUAL OF OHIO
OH000000116138OtherANTHEM BCBS
OH34-1724510-002OtherMEDICAL MUTUAL OF OHIO
U30414Medicare UPIN