Provider Demographics
NPI:1417062316
Name:ELTAYEB, BABIKER OMER (MD)
Entity Type:Individual
Prefix:
First Name:BABIKER
Middle Name:OMER
Last Name:ELTAYEB
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 1:20455 LORAIN RD
Mailing Address - Street 2:STE T-01
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-799-4224
Mailing Address - Fax:440-799-4228
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:SUITE 330
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-3150
Practice Address - Fax:330-253-6672
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.074400207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2058295Medicaid
OHG11698Medicare UPIN
OHH424230Medicare PIN
OH90113OtherQUALCHOICE
OH8390617001OtherCIGNA
OH000000129547OtherANTHEM
OHG11698Medicare UPIN