Provider Demographics
NPI:1538371810
Name:DR I N EREN MD INC
Entity type:Organization
Organization Name:DR I N EREN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:K
Authorized Official - Last Name:EREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-989-3736
Mailing Address - Street 1:1130 TOWER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-5235
Mailing Address - Country:US
Mailing Address - Phone:440-989-3736
Mailing Address - Fax:440-989-4876
Practice Address - Street 1:1130 TOWER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-5235
Practice Address - Country:US
Practice Address - Phone:440-989-3736
Practice Address - Fax:440-989-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0617818Medicaid
A15665Medicare UPIN
OH9217001Medicare PIN
OHI9217001Medicare ID - Type Unspecified