Provider Demographics
NPI:1689317810
Name:JARRAH, KAREEM (MD)
Entity type:Individual
Prefix:DR
First Name:KAREEM
Middle Name:
Last Name:JARRAH
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 1:419 E. PERKINS AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4901
Mailing Address - Country:US
Mailing Address - Phone:419-557-7455
Mailing Address - Fax:419-557-7782
Practice Address - Street 1:1111 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3323
Practice Address - Country:US
Practice Address - Phone:419-557-7455
Practice Address - Fax:419-557-7782
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.151979207P00000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0494423Medicaid
OH35.151979OtherOHIO ELICENSURE OHIO PROFESSIONAL LICENSURE