Provider Demographics
NPI:1639158827
Name:TRABOULSSI, MOURHAF (MD)
Entity Type:Individual
Prefix:DR
First Name:MOURHAF
Middle Name:
Last Name:TRABOULSSI
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 1:703 TYLER ST STE 250
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3390
Mailing Address - Country:US
Mailing Address - Phone:440-414-9300
Mailing Address - Fax:216-201-5588
Practice Address - Street 1:703 TYLER ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3367
Practice Address - Country:US
Practice Address - Phone:440-414-9300
Practice Address - Fax:216-201-5588
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073562207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060047442OtherRAILROAD MEDICARE
OH100413OtherKAISER
OH341221800083OtherCARESOURCE
OH000000128699OtherANTHEM
OHE73562OtherSUMMACARE
OHE73562OtherSUMMACARE
060047442OtherRAILROAD MEDICARE
OH2035792Medicaid