Provider Demographics
NPI:1700068095
Name:MAHMOUD ADAM, M.D. INC
Entity Type:Organization
Organization Name:MAHMOUD ADAM, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:HAMDI
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-662-6077
Mailing Address - Street 1:12000 MCCRACKEN ROAD,
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-662-6077
Mailing Address - Fax:216-581-8937
Practice Address - Street 1:12000 MCCRACKEN ROAD,
Practice Address - Street 2:SUITE 106
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125
Practice Address - Country:US
Practice Address - Phone:216-662-6077
Practice Address - Fax:216-581-8937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0613184Medicaid
OH0613184Medicaid