MEDICARE: RIDWAN M. TARABISHI MD

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	2080P0210X	Pediatric Nephrology Physician	4301064550	MI
2	2080P0210X	Pediatric Nephrology Physician	35070302	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346233319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIDWAN M. TARABISHI MD

Provider Business Mailing Address
First Line	:	2222 CHERRY ST STE 2300
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2675
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 CHERRY ST STE 2300
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2675
Country	:	US
Telephone Number	:	419-251-8030
Fax Number	:	419-251-7764

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	06/20/2023

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