Provider Demographics
NPI:1164731493
Name:FAMILY CARE OF WAUSEON LLC
Entity Type:Organization
Organization Name:FAMILY CARE OF WAUSEON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DABOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-866-7166
Mailing Address - Street 1:PO BOX 351328
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-1328
Mailing Address - Country:US
Mailing Address - Phone:419-335-4600
Mailing Address - Fax:416-335-4900
Practice Address - Street 1:368 W ELM ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1164
Practice Address - Country:US
Practice Address - Phone:419-335-4600
Practice Address - Fax:416-335-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9392531Medicare PIN