Healthcare Provider Details

I. General information

NPI: 1023945367
Provider Name (Legal Business Name): BASEL S DIAB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5219
US

IV. Provider business mailing address

4098 DRYDEN DR
NORTH OLMSTED OH
44070-1928
US

V. Phone/Fax

Practice location:
  • Phone: 440-827-2921
  • Fax:
Mailing address:
  • Phone: 216-269-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58.035844
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: