Provider Demographics
NPI:1861836884
Name:MUAKKASSA, FUAD KAMEL (MD)
Entity Type:Individual
Prefix:DR
First Name:FUAD
Middle Name:KAMEL
Last Name:MUAKKASSA
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 1:29111 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4005
Mailing Address - Country:US
Mailing Address - Phone:404-430-4234
Mailing Address - Fax:440-443-0414
Practice Address - Street 1:29111 CEDAR RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4005
Practice Address - Country:US
Practice Address - Phone:404-430-4234
Practice Address - Fax:440-443-0414
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
AZ62133207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ62133OtherMEDICAL LICENSE