Provider Demographics
NPI:1720222813
Name:MOINI, BABAK ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:BABAK
Middle Name:ROBERT
Last Name:MOINI
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 1:5850 LANDERBROOK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4071
Mailing Address - Country:US
Mailing Address - Phone:440-646-2200
Mailing Address - Fax:440-646-2209
Practice Address - Street 1:5850 LANDERBROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4071
Practice Address - Country:US
Practice Address - Phone:440-646-2200
Practice Address - Fax:440-646-2209
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120505207R00000X
OH35.120508208000000X
CODR.0057136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics