Provider Demographics
NPI:1639356116
Name:BADR K. GHUMRAWI, M.D. INC.
Entity Type:Organization
Organization Name:BADR K. GHUMRAWI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BADR
Authorized Official - Middle Name:K
Authorized Official - Last Name:GHUMRAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-296-2829
Mailing Address - Street 1:6693 N CHESTNUT ST
Mailing Address - Street 2:SUITE 268A
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3922
Mailing Address - Country:US
Mailing Address - Phone:330-296-2829
Mailing Address - Fax:330-296-7202
Practice Address - Street 1:6693 N CHESTNUT ST
Practice Address - Street 2:SUITE 268A
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3922
Practice Address - Country:US
Practice Address - Phone:330-296-2829
Practice Address - Fax:330-296-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-27
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036836208600000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000129043OtherANTHEM
099507636OtherWORKERS COMPENSATION
27174OtherNATIONWIDE
OH0231538Medicaid
4132029OtherAETNA
71479OtherQUALCHOICE
100430OtherKAISER
4132029OtherAETNA
000000129043OtherANTHEM
OH0231538Medicaid