Provider Demographics
NPI:1902118136
Name:TELLO, MUHANNAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHANNAD
Middle Name:
Last Name:TELLO
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 1:18660 BAGLEY RD STE 401
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3483
Mailing Address - Country:US
Mailing Address - Phone:440-243-6556
Mailing Address - Fax:440-243-6226
Practice Address - Street 1:18660 BAGLEY RD STE 401
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-243-6556
Practice Address - Fax:440-243-6226
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138261207RI0200X
PAMD450333208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102885246 0001Medicaid
PA325454PUDMedicare PIN