1386886851 NPI number — DR. BILAL MOUSA ATAYA M.D.

Table of content: DR. BILAL MOUSA ATAYA M.D. (NPI 1386886851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386886851 NPI number — DR. BILAL MOUSA ATAYA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATAYA
Provider First Name:
BILAL
Provider Middle Name:
MOUSA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386886851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1580 E CROSSINGS PL
Provider Second Line Business Mailing Address:
APT/SUITE
Provider Business Mailing Address City Name:
WESTLAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44145-6239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-659-3035
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30680 BAINBRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44139-2282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-542-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  35.099050 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)