Provider Demographics
NPI:1922317122
Name:ABUSAG, MILAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MILAD
Middle Name:
Last Name:ABUSAG
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 1:905 SAHARA TRL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3687
Mailing Address - Country:US
Mailing Address - Phone:330-729-8970
Mailing Address - Fax:330-729-8971
Practice Address - Street 1:905 SAHARA TRL
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514
Practice Address - Country:US
Practice Address - Phone:330-729-8970
Practice Address - Fax:330-729-8971
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.132632207RE0101X
IL036132489207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA412580Medicare PIN