Provider Demographics
NPI:1326775164
Name:OBIED, MUDATHIR N
Entity Type:Individual
Prefix:
First Name:MUDATHIR
Middle Name:N
Last Name:OBIED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 PLEASANT MEADOW BLVD APT F
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4980
Mailing Address - Country:US
Mailing Address - Phone:614-805-4861
Mailing Address - Fax:
Practice Address - Street 1:364 PLEASANT MEADOW BLVD APT F
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4980
Practice Address - Country:US
Practice Address - Phone:614-805-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)