Provider Demographics
NPI:1518968569
Name:MOUGINIS, TAMYRA L (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:TAMYRA
Middle Name:L
Last Name:MOUGINIS
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3400
Mailing Address - Country:US
Mailing Address - Phone:440-572-3733
Mailing Address - Fax:
Practice Address - Street 1:13500 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3400
Practice Address - Country:US
Practice Address - Phone:440-572-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058913207L00000X
OH35-05-8913207R00000X
OH35-058913208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2510929Medicaid
F19852Medicare UPIN
OHMO4140251Medicare ID - Type Unspecified
OH2510929Medicaid