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NPI Code Detail

MEDICARE: IBRAHIM MASOUD

MEDICARE: IBRAHIM MASOUD
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
11223G0001XGeneral Practice Dentistry004003OH

General Provider Information

NPI Number : 1457818692
Entity Type Code : Individual
Provider Name (Legal Business Name) : IBRAHIM MASOUD
Provider Business Mailing Address
First Line : 4071 LEE RD STE 260
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-2173
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4071 LEE RD STE 260
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-2173
Country : US
Telephone Number : 727-877-9669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2019
Last Update Date : 02/25/2019

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Directions to “ IBRAHIM MASOUD ” Practice Location

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