Healthcare Provider Details

I. General information

NPI: 1508369851
Provider Name (Legal Business Name): EL-HALLAK RHEUMATOLOGY AND SPECIALTY INFUSION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23215 COMMERCE PARK STE 318
BEACHWOOD OH
44122-5803
US

IV. Provider business mailing address

23215 COMMERCE PARK STE 318
BEACHWOOD OH
44122-5803
US

V. Phone/Fax

Practice location:
  • Phone: 216-755-4044
  • Fax: 330-967-0571
Mailing address:
  • Phone: 216-755-4044
  • Fax: 330-967-0571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number35.129222
License Number StateOH

VIII. Authorized Official

Name: MOUSSA EL-HALLAK
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 216-755-4044