Healthcare Provider Details

I. General information

NPI: 1700823994
Provider Name (Legal Business Name): BABU EAPEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7255 OLD OAK BLVD STE C106
MIDDLEBURG HEIGHTS OH
44130-3329
US

IV. Provider business mailing address

PO BOX 639004
CINCINNATI OH
45263-9004
US

V. Phone/Fax

Practice location:
  • Phone: 440-826-3031
  • Fax: 440-625-0788
Mailing address:
  • Phone: 440-895-5056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35-060080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: