Healthcare Provider Details

I. General information

NPI: 1518921980
Provider Name (Legal Business Name): BASHAR N JOUMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 MONCLOVA RD HEART CENTER
MAUMEE OH
43537-1841
US

IV. Provider business mailing address

31014 BEL AIRE CIRCLE
WESTLAKE OH
44145
US

V. Phone/Fax

Practice location:
  • Phone: 419-893-5911
  • Fax:
Mailing address:
  • Phone: 440-263-8645
  • Fax: 440-760-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35078523J
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35.078523
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: