Provider Demographics
NPI:1841600574
Name:TAYIM, RIYAD J (MD)
Entity type:Individual
Prefix:
First Name:RIYAD
Middle Name:J
Last Name:TAYIM
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 1:3533 SOUTHERN BLVD STE 2250
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1270
Mailing Address - Country:US
Mailing Address - Phone:937-534-0330
Mailing Address - Fax:937-522-8995
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:STE 2250
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1270
Practice Address - Country:US
Practice Address - Phone:937-534-0330
Practice Address - Fax:937-522-8995
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.130996208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0371274Medicaid