MEDICARE: IDEALCARE LLC

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	207R00000X	Internal Medicine Physician

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	:	1396273686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEALCARE LLC

Provider Business Mailing Address
First Line	:	28676 WEYBRIDGE DR
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-6753
Country	:	US
Telephone Number	:	419-709-6480
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 HAYES AVE STE 2
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5391
Country	:	US
Telephone Number	:	419-709-6480
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AHMAD FIRAS SABBAGH
Credential	:	MD
Telephone Number	:	419-709-6480

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	05/31/2017

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