Healthcare Provider Details

I. General information

NPI: 1720222813
Provider Name (Legal Business Name): BABAK ROBERT MOINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 08/05/2025
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 ORANGE PLACE SUITE 300
BEACHWOOD OH
44122
US

IV. Provider business mailing address

3690 ORANGE PLACE SUITE 300
BEACHWOOD OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-260-3550
  • Fax: 216-265-5015
Mailing address:
  • Phone: 216-260-3550
  • Fax: 216-265-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.120505
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0057136
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.120508
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: