Healthcare Provider Details

I. General information

NPI: 1053317073
Provider Name (Legal Business Name): HUSSEIN IBRAHIM KASHK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 BELLEFONTAINE AVE
LIMA OH
45804-2888
US

IV. Provider business mailing address

967 BELLEFONTAINE AVE
LIMA OH
45804-2888
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5895
  • Fax:
Mailing address:
  • Phone: 419-996-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35073548
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.073548
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2052013
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 2
Identifier1053317073
Identifier TypeMEDICAID
Identifier StateWV
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: