Provider Demographics
NPI:1386724474
Name:SETRAKIAN, SEBOUH (MD)
Entity type:Individual
Prefix:
First Name:SEBOUH
Middle Name:
Last Name:SETRAKIAN
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 1:18101 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5612
Mailing Address - Country:US
Mailing Address - Phone:216-476-4825
Mailing Address - Fax:216-476-7109
Practice Address - Street 1:18101 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5612
Practice Address - Country:US
Practice Address - Phone:216-476-4825
Practice Address - Fax:216-476-7109
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.061729207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH340714618011OtherMEDICAL MUTUAL OF OHIO
OH0110641OtherBCMH
OH000000023743OtherUNICARE
OH0110641Medicaid
OH340714618144OtherCARESOURCE
OH5954238OtherAETNA US HEALTHCARE
OH000000023743OtherANTHEM BC/BS
OH1100289OtherUNITED HEALTH CARE
OH1316OtherUNITED MINE WORKERS OF AM
OH000000023743OtherOHIO OPERATING ENGINEERS
OH1100289OtherUNITED HEALTH CARE