Provider Demographics
NPI:1508552225
Name:DOUGLAS MOINUDDIN
Entity Type:Organization
Organization Name:DOUGLAS MOINUDDIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOINUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-533-4449
Mailing Address - Street 1:PO BOX 451452
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0639
Mailing Address - Country:US
Mailing Address - Phone:216-533-4449
Mailing Address - Fax:
Practice Address - Street 1:28360 CENTER RIDGE RD APT 229
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6797
Practice Address - Country:US
Practice Address - Phone:216-533-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty