Provider Demographics
NPI:1811910284
Name:DROUBI, BASEM (MD)
Entity type:Individual
Prefix:DR
First Name:BASEM
Middle Name:
Last Name:DROUBI
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 1:20997 LORAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2030
Mailing Address - Country:US
Mailing Address - Phone:440-356-1009
Mailing Address - Fax:440-356-1014
Practice Address - Street 1:20997 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2030
Practice Address - Country:US
Practice Address - Phone:440-356-1009
Practice Address - Fax:440-356-1014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350403532086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0471181Medicaid
OH0471181Medicaid
OHA15208Medicare UPIN