Provider Demographics
NPI:1750358941
Name:AL-MUBARAK, NADIM (MD)
Entity type:Individual
Prefix:
First Name:NADIM
Middle Name:
Last Name:AL-MUBARAK
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 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-835-8922
Mailing Address - Fax:440-835-4788
Practice Address - Street 1:29101 HEALTH CAMPUS DR BLDG 2
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5270
Practice Address - Country:US
Practice Address - Phone:440-835-8922
Practice Address - Fax:440-835-4788
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 08 0671 A207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2300567Medicaid
OH2300567Medicaid
OH4188202Medicare PIN