Provider Demographics
NPI:1104978048
Name:ELYAN, MAZEN (MD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:ELYAN
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-1900
Mailing Address - Fax:859-344-4632
Practice Address - Street 1:651 CENTRE VIEW BOULEVARD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5419
Practice Address - Country:US
Practice Address - Phone:859-344-1900
Practice Address - Fax:859-344-4632
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35085724207RR0500X
IN01072711A207RR0500X
KY52243207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology