Provider Demographics
NPI:1982892493
Name:GIRGIS, GIRGIS EMIL (DO)
Entity Type:Individual
Prefix:
First Name:GIRGIS EMIL
Middle Name:
Last Name:GIRGIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 LEAVITT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2139
Mailing Address - Country:US
Mailing Address - Phone:440-989-2066
Mailing Address - Fax:440-989-1153
Practice Address - Street 1:4804 LEAVITT RD
Practice Address - Street 2:SUITE A
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2139
Practice Address - Country:US
Practice Address - Phone:440-989-2066
Practice Address - Fax:440-989-1153
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008998207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000587503OtherANTHEM
OH341961205030OtherCARESOURCE
OH0362393OtherCIGNA HOM/PPO
OH2782501Medicaid
OHP00699814OtherRR MEDICARE
OH0362393OtherCIGNA HOM/PPO
OH2782501Medicaid
OH2782501Medicaid