Provider Demographics
NPI:1679825442
Name:ABDEL JALIL, RIAD (MD)
Entity type:Individual
Prefix:
First Name:RIAD
Middle Name:
Last Name:ABDEL JALIL
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 1:12550 LAKE AVE
Mailing Address - Street 2:LAKEWOOD
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1575
Mailing Address - Country:US
Mailing Address - Phone:216-235-4609
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program