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General NPI Number Information
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NPI Number | 1720297211
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Entity Type | Individual
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Provider Name | MUAWIA ABUSHUKUR
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 3500 KOLBE RD PALLIATIVE CARE DEPT
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City | LORAIN
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State | OH
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Zip | 44053-1632
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Country | US
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Telephone | 440-960-4900
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Fax | 440-934-1567
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Provider Business Mailing Address
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Address Line | PO BOX 636643
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City | CINCINNATI
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State | OH
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Zip | 45263-6643
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Country | US
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Telephone | 440-960-4900
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Fax | 440-934-1567
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301083368
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35126011
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License Number State | OH
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