Healthcare Provider Details

I. General information

NPI: 1891376778
Provider Name (Legal Business Name): SHIAB MUSSAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER 395 W 12TH AVENUE, THIRD FLOOR
COLUMBUS OH
43210
US

IV. Provider business mailing address

THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER 395 W 12TH AVENUE, THIRD FLOOR
COLUMBUS OH
43210
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3989
  • Fax: 614-293-9789
Mailing address:
  • Phone: 614-293-3989
  • Fax: 614-293-9789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301511273
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301511273
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: