Provider Demographics
NPI:1467441030
Name:ABU-SHAWEESH, JALAL M (MD)
Entity Type:Individual
Prefix:
First Name:JALAL
Middle Name:M
Last Name:ABU-SHAWEESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CTR RD
Mailing Address - Street 2:1ST FL MSC 9152
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069777208000000X, 2080N0001X
OH35-069777207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237578Medicaid
OH2140105OtherBCMH
PA1010858470001OtherPA MEDICAID
OH363295OtherWELLCARE
OHP00411224OtherRAILROAD MEDICARE
OH2140105Medicaid
OH2146054OtherAETNA
OH000000525865OtherANTHEM
OH735607OtherBUCKEYE
OH000000221382OtherUNISON
G97016Medicare UPIN
OH0237578Medicaid
OH2146054OtherAETNA