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General NPI Number Information
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NPI Number | 1467563429
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Entity Type | Individual
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Provider Name | BASEL MOUSSA MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 20997 LORAIN RD
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City | FAIRVIEW PARK
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State | OH
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Zip | 44176
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Country | US
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Telephone | 440-356-6666
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Fax | 440-356-6651
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Provider Business Mailing Address
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Address Line | PO BOX 450615
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City | WEST LAKE
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State | OH
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Zip | 44145
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Country | US
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Telephone | 440-356-6666
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Fax | 440-356-6651
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 35-071087
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License Number State | OH
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