Provider Demographics
NPI:1932489291
Name:PROACTIVE CARDIOLOGY LLC
Entity Type:Organization
Organization Name:PROACTIVE CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUHAMAD
Authorized Official - Middle Name:SAMER
Authorized Official - Last Name:KABBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-994-4081
Mailing Address - Street 1:38165 HIGHGATE BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7735
Mailing Address - Country:US
Mailing Address - Phone:440-994-4081
Mailing Address - Fax:440-209-7789
Practice Address - Street 1:2614 HUBBARD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2530
Practice Address - Country:US
Practice Address - Phone:440-994-4081
Practice Address - Fax:440-209-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090479207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty