Provider Demographics
NPI:1518921980
Name:JOUMA, BASHAR N (MD)
Entity Type:Individual
Prefix:
First Name:BASHAR
Middle Name:N
Last Name:JOUMA
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 1:31014 BEL AIRE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-263-8645
Mailing Address - Fax:440-760-2276
Practice Address - Street 1:5901 MONCLOVA RD
Practice Address - Street 2:HEART CENTER
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1841
Practice Address - Country:US
Practice Address - Phone:419-893-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078523J207L00000X
OH35.078523207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2324283Medicaid
OH2324283Medicaid