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General NPI Number Information
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NPI Number | 1306805304
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Entity Type | Individual
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Provider Name | MOHAMED BASHAR MAMLOUK MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 20455 LORAIN RD STE 104B
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-3529
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Country | US
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Telephone | 440-356-2715
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Fax | 440-356-6978
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Provider Business Mailing Address
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Address Line | 30701 LORAIN RD STE A
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-6325
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Country | US
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Telephone | 440-274-5035
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Fax | 440-716-8608
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35-038540
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License Number State | OH
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