Healthcare Provider Details

I. General information

NPI: 1992322556
Provider Name (Legal Business Name): KHETAM MOHAMMED ABED NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30575 BRAINBRIDGE ROAD SUITE 200
SOLON OH
44139
US

IV. Provider business mailing address

29787 VITA LN
NORTH OLMSTED OH
44070-5028
US

V. Phone/Fax

Practice location:
  • Phone: 440-542-5000
  • Fax:
Mailing address:
  • Phone: 440-823-9437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number026222
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: