Healthcare Provider Details

I. General information

NPI: 1467441030
Provider Name (Legal Business Name): JALAL M ABU-SHAWEESH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVENUE
CLEVELAND OH
44106
US

IV. Provider business mailing address

3605 WARRENSVILLE CTR RD 1ST FL MSC 9152
SHAKER HTS OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7700
  • Fax: 216-286-6341
Mailing address:
  • Phone: 216-286-6299
  • Fax: 216-286-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35-069777
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35069777
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35069777
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number35-069777
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: