Provider Demographics
NPI:1386063816
Name:TAVAKOLI, VAHID (MD)
Entity type:Individual
Prefix:
First Name:VAHID
Middle Name:
Last Name:TAVAKOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VAHID
Other - Middle Name:
Other - Last Name:TAVAKOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1003 BELLEFONTAINE AVE STE 200
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1803
Practice Address - Country:US
Practice Address - Phone:419-224-5915
Practice Address - Fax:419-224-5918
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.139298207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease