MEDICARE: MOHAMED M AL-MADANI M.D.

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	207V00000X	Obstetrics & Gynecology Physician	35-043768	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000311271	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1518933621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED M AL-MADANI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 30633
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-0633
Country	:	US
Telephone Number	:	440-879-0081
Fax Number	:	440-879-0084

Provider Business Practice Location Address
First Line	:	155 5TH ST NE
Second Line	:
City	:	BARBERTON
State	:	OH
Zip	:	44203-3332
Country	:	US
Telephone Number	:	330-745-1611
Fax Number	:

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/11/2007

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