Healthcare Provider Details

I. General information

NPI: 1861402745
Provider Name (Legal Business Name): ENDOCRINE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 N HOLLAND SYLVANIA RD SUITE 140
TOLEDO OH
43623-2504
US

IV. Provider business mailing address

4126 N HOLLAND SYLVANIA RD SUITE 140
TOLEDO OH
43623-2504
US

V. Phone/Fax

Practice location:
  • Phone: 419-472-7755
  • Fax: 419-472-8811
Mailing address:
  • Phone: 419-472-7755
  • Fax: 419-472-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35067199
License Number StateOH

VIII. Authorized Official

Name: DR. MAHMOOD FATTOOH MOOSA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 419-472-7755