Healthcare Provider Details

I. General information

NPI: 1659539245
Provider Name (Legal Business Name): BASSEL MICHEL CHOUFANI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BOARDMAN CANFIELD RD
BOARDMAN OH
44512-4218
US

IV. Provider business mailing address

6730 LANGSTON RUN
CANFIELD OH
44406-9284
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-0075
  • Fax:
Mailing address:
  • Phone: 401-688-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLPR00176
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD12728
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD157673
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number127859
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: