MEDICARE: MIRA MOURAD MORCOS ABOELKHEIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	RES004709	OH

General Provider Information

NPI Number	:	1033947080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRA MOURAD MORCOS ABOELKHEIR

Provider Business Mailing Address
First Line	:	3701 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3707
Country	:	US
Telephone Number	:	216-778-4725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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Directions to “ MIRA MOURAD MORCOS ABOELKHEIR ” Practice Location

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