Provider Demographics
NPI:1992791388
Name:MIGALLY, MAGDY B (MD)
Entity type:Individual
Prefix:DR
First Name:MAGDY
Middle Name:B
Last Name:MIGALLY
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 1:5212 BRANDT PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6138
Mailing Address - Country:US
Mailing Address - Phone:937-233-0748
Mailing Address - Fax:937-233-6086
Practice Address - Street 1:5212 BRANDT PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-6138
Practice Address - Country:US
Practice Address - Phone:937-233-0748
Practice Address - Fax:937-233-6086
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-3565-M207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000066851OtherANTHEM PIN-L
OH0470022OtherPTAN
OH0470024OtherPTAN
OH000000011390OtherANTHEM PIN-C
OH0470029OtherPTAN
OH0735331OtherPTAN
OH000000011389OtherANTHEM PIN-U
OH000000011389OtherANTHEM PIN-U
OH000000011390OtherANTHEM PIN-C