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General NPI Number Information
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NPI Number | 1558477489
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Entity Type | Individual
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Provider Name | WISSAM BLEIBEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 2702 NAVARRE AVE SUITE 320
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City | OREGON
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State | OH
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Zip | 43616-3223
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Country | US
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Telephone | 419-696-5555
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Fax | 419-696-8499
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Provider Business Mailing Address
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Address Line | 2200 JEFFERSON AVE 5TH FL
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City | TOLEDO
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State | OH
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Zip | 43604-7101
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Country | US
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Telephone |
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Fax |
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 44628
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0101245745
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35128599
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 01095562A
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License Number State | IN
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