Healthcare Provider Details

I. General information

NPI: 1639123409
Provider Name (Legal Business Name): MUSSARET ZUBERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E RIVER ST EMERGENCY DEPARTMENT
ELYRIA OH
44035-5902
US

IV. Provider business mailing address

32119 WILLOW CIR
AVON LAKE OH
44012-2133
US

V. Phone/Fax

Practice location:
  • Phone: 440-329-7450
  • Fax: 440-329-7646
Mailing address:
  • Phone: 440-930-2077
  • Fax: 440-988-6661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.063506
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME94632
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number78050
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: