MEDICARE: MAHA M A AL TAWALBEH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1255103974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHA M A AL TAWALBEH

Provider Business Mailing Address
First Line	:	2703 COVENTRY RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-1307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2703 COVENTRY RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-1307
Country	:	US
Telephone Number	:	312-721-8551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	12/11/2023

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Directions to “ MAHA M A AL TAWALBEH ” Practice Location

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