Provider Demographics
NPI:1720297211
Name:ABUSHUKUR, MUAWIA
Entity Type:Individual
Prefix:
First Name:MUAWIA
Middle Name:
Last Name:ABUSHUKUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-960-4900
Mailing Address - Fax:440-934-1567
Practice Address - Street 1:3500 KOLBE RD
Practice Address - Street 2:PALLIATIVE CARE DEPT
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1632
Practice Address - Country:US
Practice Address - Phone:440-960-4900
Practice Address - Fax:440-934-1567
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083368207Q00000X
OH35126011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0207207Medicaid
OH9288887Medicare PIN
OH0207207Medicaid