MEDICARE: DR. BABAK TOUSI M.D.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	35083489	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000368729	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720074495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BABAK TOUSI M.D.

Provider Business Mailing Address
First Line	:	1730 W 25TH ST
Second Line	:	SUITE 2A
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3108
Country	:	US
Telephone Number	:	216-363-2319
Fax Number	:	216-363-2356

Provider Business Practice Location Address
First Line	:	1730 W 25TH ST
Second Line	:	SUITE 2A
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3108
Country	:	US
Telephone Number	:	216-363-2319
Fax Number	:	216-363-2356

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	11/30/2009

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