Healthcare Provider Details

I. General information

NPI: 1477728517
Provider Name (Legal Business Name): AHSAN MOOSA NADUVIL VALAPPIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 N MORELAND BLVD APT 605
CLEVELAND OH
44120-1472
US

IV. Provider business mailing address

2515 KEMPER RD APT 209
SHAKER HEIGHTS OH
44120-5500
US

V. Phone/Fax

Practice location:
  • Phone: 216-921-1254
  • Fax: 216-445-9139
Mailing address:
  • Phone: 216-921-1254
  • Fax: 216-445-9139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number67581
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35.099064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: