Provider Demographics
NPI:1790811438
Name:MOUKARBEL, GEORGE VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:VICTOR
Last Name:MOUKARBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4510 DORR ST # MS 840
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4040
Mailing Address - Country:US
Mailing Address - Phone:419-931-0030
Mailing Address - Fax:419-931-5411
Practice Address - Street 1:5757 MONCLOVA RD STE 1
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1863
Practice Address - Country:US
Practice Address - Phone:419-931-0030
Practice Address - Fax:419-931-5411
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098150207RI0011X, 207RC0000X
MA234203207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0057534Medicaid