Provider Demographics
NPI:1053317073
Name:KASHK, HUSSEIN IBRAHIM (MD)
Entity Type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:IBRAHIM
Last Name:KASHK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2888
Mailing Address - Country:US
Mailing Address - Phone:419-996-5895
Mailing Address - Fax:
Practice Address - Street 1:967 BELLEFONTAINE AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2888
Practice Address - Country:US
Practice Address - Phone:419-996-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073548208000000X
OH35.073548207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2052013Medicaid
WV1053317073Medicaid
OHG76267Medicare UPIN