Healthcare Provider Details

I. General information

NPI: 1497733075
Provider Name (Legal Business Name): MUSHTAQ MAHMOOD MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MUSHTAQ MAHMOOD MD

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10325 DEWHURST RD OHIO MEDICAL GROUP
ELYRIA OH
44035-8403
US

IV. Provider business mailing address

10325 DEWHURST RD
ELYRIA OH
44035-8403
US

V. Phone/Fax

Practice location:
  • Phone: 440-414-9260
  • Fax: 216-201-5581
Mailing address:
  • Phone: 440-414-9260
  • Fax: 216-201-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number57.016032
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number57.016032
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: