Healthcare Provider Details

I. General information

NPI: 1891928990
Provider Name (Legal Business Name): MOHAMMAD TALEB M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 11/03/2023
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST STE 240
LIMA OH
45801-5906
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-2686
  • Fax: 419-996-2687
Mailing address:
  • Phone: 419-720-0318
  • Fax: 419-720-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.099238
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number099238
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number099238
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: