Provider Demographics
NPI:1639149131
Name:WANESS, ABDELKARIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDELKARIM
Middle Name:
Last Name:WANESS
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 1:1220 MOORE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4044
Mailing Address - Country:US
Mailing Address - Phone:440-930-4446
Mailing Address - Fax:440-934-0682
Practice Address - Street 1:10325 DEWHURST RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-8403
Practice Address - Country:US
Practice Address - Phone:440-366-3600
Practice Address - Fax:440-365-8826
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128702OtherANTHEM
OHE66110OtherSUMMA
OH0979508Medicaid
F84442Medicare UPIN
WA0893051Medicare ID - Type Unspecified