Healthcare Provider Details

I. General information

NPI: 1316052806
Provider Name (Legal Business Name): F K ABBOUSY MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S PROSPECT AVE SUITE 202
HARTVILLE OH
44632
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708
US

V. Phone/Fax

Practice location:
  • Phone: 330-877-7755
  • Fax: 330-877-7754
Mailing address:
  • Phone: 330-833-5530
  • Fax: 330-833-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35032086
License Number StateOH

VIII. Authorized Official

Name: FADHIL K ABBOUSY
Title or Position: DOCTOR
Credential: MD
Phone: 330-877-7755