Provider Demographics
NPI:1508369851
Name:EL-HALLAK RHEUMATOLOGY AND SPECIALTY INFUSION SERVICES LLC
Entity Type:Organization
Organization Name:EL-HALLAK RHEUMATOLOGY AND SPECIALTY INFUSION SERVICES LLC
Other - Org Name:CAREPOINT RHEUMATOLOGY AND SPECIALTY INFUSION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MOUSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-HALLAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-755-4044
Mailing Address - Street 1:23215 COMMERCE PARK STE 318
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5803
Mailing Address - Country:US
Mailing Address - Phone:216-755-4044
Mailing Address - Fax:330-967-0571
Practice Address - Street 1:23215 COMMERCE PARK STE 318
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5803
Practice Address - Country:US
Practice Address - Phone:216-755-4044
Practice Address - Fax:330-967-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
OH35.1292222080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric RheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0272503Medicaid