Healthcare Provider Details

I. General information

NPI: 1558323238
Provider Name (Legal Business Name): TOLEDO CRITICAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

IV. Provider business mailing address

601 WASHINGTON AVE SUITE 390
NEWPORT KY
41071-1986
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-4000
  • Fax:
Mailing address:
  • Phone: 859-291-4800
  • Fax: 859-655-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHRAF BANOUB
Title or Position: PRESIDENT
Credential: MD
Phone: 419-291-4800