Healthcare Provider Details

I. General information

NPI: 1730460205
Provider Name (Legal Business Name): NORTH SHORE ANESTHESIA LIMITED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145-7215
US

IV. Provider business mailing address

850 COLUMBIA RD SUITE 200
WESTLAKE OH
44145-1493
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-1212
  • Fax: 440-808-2060
Mailing address:
  • Phone: 440-808-1212
  • Fax: 440-808-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOUSAB I TABBAA
Title or Position: PRESIDENT
Credential: MD
Phone: 440-808-1212