Provider Demographics
NPI:1306055322
Name:POREH, AMIR M (PHD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:M
Last Name:POREH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 ENTERPRISE PKWY STE 340
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7340
Practice Address - Country:US
Practice Address - Phone:216-577-9342
Practice Address - Fax:855-506-8346
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6082103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00668462OtherMEDICARE RAILROAD
OH000000533017OtherANTHEM
OH9582065OtherAETNA
OH000000224466OtherUNISON
OH000000533017OtherANTHEM
OH9582065OtherAETNA
OH9582065OtherAETNA