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General NPI Number Information
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NPI Number | 1932121050
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Entity Type | Organization
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Legal Business Name | NORTH SHORE GASTROENTEROLOGY, INC.
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 850 COLUMBIA RD STE 200
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City | WESTLAKE
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State | OH
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Zip | 44145-7215
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Country | US
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Telephone | 440-808-1212
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Fax | 440-808-0321
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Provider Business Mailing Address
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Address Line | 850 COLUMBIA RD STE 200
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City | WESTLAKE
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State | OH
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Zip | 44145-7215
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Country | US
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Telephone | 440-808-1212
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Fax | 440-808-0321
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOUSAB I TABBAA
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Credential | MD
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Telephone | 440-808-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0008X
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Taxonomy Name | Hepatology Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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