Healthcare Provider Details

I. General information

NPI: 1023266533
Provider Name (Legal Business Name): MUHANNAD KASSAWAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11369 MARKET ST
NORTH LIMA OH
44452-9782
US

IV. Provider business mailing address

11369 MARKET ST
NORTH LIMA OH
44452-9782
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 234-759-3971
Mailing address:
  • Phone: 330-965-9999
  • Fax: 234-759-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301505923
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberS2364
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME105224
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number35.092211
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: