Provider Demographics
NPI:1679156681
Name:ANIS, MEHRUNISSA KAISER (MD)
Entity type:Individual
Prefix:DR
First Name:MEHRUNISSA
Middle Name:KAISER
Last Name:ANIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEHRUNNISA
Other - Middle Name:KAISER
Other - Last Name:ANIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5595 TRANSPORTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5379
Mailing Address - Country:US
Mailing Address - Phone:216-518-4633
Mailing Address - Fax:
Practice Address - Street 1:5595 TRANSPORTATION BLVD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5379
Practice Address - Country:US
Practice Address - Phone:216-518-4633
Practice Address - Fax:724-324-9005
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
OH35.152111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program