Healthcare Provider Details

I. General information

NPI: 1174964787
Provider Name (Legal Business Name): ATALLAH BAYDOUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE UNIVERSITY HOSPITALS CASE MEDICAL CENTER
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3951
  • Fax:
Mailing address:
  • Phone: 216-844-3951
  • Fax: 216-286-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.023062
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35.126872
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: