Provider Demographics
NPI:1134178932
Name:BASHOUR, FADI S (MD)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:S
Last Name:BASHOUR
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 1:7575 NORTHCLIFF AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3267
Mailing Address - Country:US
Mailing Address - Phone:216-398-5988
Mailing Address - Fax:216-398-5832
Practice Address - Street 1:7575 NORTHCLIFF AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3267
Practice Address - Country:US
Practice Address - Phone:216-398-5988
Practice Address - Fax:216-398-5832
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065516207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH160056024OtherRAILROAD CARE
OHP00705906OtherRRCARE
OH350267OtherWELLCARE
OH000000215837OtherANTHEM BC/BS
OH0940512Medicaid
OH4044593Medicare PIN
OHP00705906OtherRRCARE
OH7425241Medicare PIN
OH7296961Medicare PIN