Provider Demographics
NPI:1417970922
Name:INTERNAL MEDICINE ASSOCIATES OF MID-OHIO INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF MID-OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARBADAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-747-1601
Mailing Address - Street 1:465 NORTH HOME RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2323
Mailing Address - Country:US
Mailing Address - Phone:419-747-1601
Mailing Address - Fax:419-747-1610
Practice Address - Street 1:465 NORTH HOME RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2323
Practice Address - Country:US
Practice Address - Phone:419-747-1601
Practice Address - Fax:419-747-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2131231Medicaid
OH2131231Medicaid
OHGA0892072Medicare ID - Type Unspecified