Provider Demographics
NPI:1962083063
Name:SHREIQEIN, RAFAT M
Entity type:Individual
Prefix:
First Name:RAFAT
Middle Name:M
Last Name:SHREIQEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 BENNIGAN DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8257
Mailing Address - Country:US
Mailing Address - Phone:614-401-0011
Mailing Address - Fax:614-319-3319
Practice Address - Street 1:1822 BENNIGAN DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8257
Practice Address - Country:US
Practice Address - Phone:614-401-0011
Practice Address - Fax:614-319-3319
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty