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General NPI Number Information
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NPI Number | 1508552225
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Entity Type | Organization
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Legal Business Name | DOUGLAS MOINUDDIN
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 28360 CENTER RIDGE RD APT 229
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City | WESTLAKE
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State | OH
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Zip | 44145-6797
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Country | US
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Telephone | 216-533-4449
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 451452
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City | WESTLAKE
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State | OH
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Zip | 44145-0639
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Country | US
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Telephone | 216-533-4449
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | DOUGLAS MOINUDDIN
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Credential |
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Telephone | 216-533-4449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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