Provider Demographics
NPI:1629036884
Name:MUBASHIR, EISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:EISHA
Middle Name:
Last Name:MUBASHIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EISHA
Other - Middle Name:
Other - Last Name:MUKHTAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3020 N MCCORD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1702
Mailing Address - Country:US
Mailing Address - Phone:419-517-1115
Mailing Address - Fax:419-517-1109
Practice Address - Street 1:3020 N MCCORD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1702
Practice Address - Country:US
Practice Address - Phone:419-517-1115
Practice Address - Fax:419-517-1109
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA199939207RR0500X
OH35088828207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2700705Medicaid
W01562Medicare UPIN
OHH307690Medicare PIN
OH4195264Medicare PIN