Healthcare Provider Details

I. General information

NPI: 1386393098
Provider Name (Legal Business Name): MICHAEL MOUSSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 PEARL RD STE 200
CLEVELAND OH
44130-4941
US

IV. Provider business mailing address

7003 PEARL RD STE 200
CLEVELAND OH
44130-4941
US

V. Phone/Fax

Practice location:
  • Phone: 440-333-3097
  • Fax: 440-333-0273
Mailing address:
  • Phone: 440-333-3097
  • Fax: 440-333-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.156770
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: