Provider Demographics
NPI:1831381524
Name:EL-HALLAK, MOUSSA (MD)
Entity type:Individual
Prefix:DR
First Name:MOUSSA
Middle Name:
Last Name:EL-HALLAK
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 1:23215 COMMERCE PARK STE 318
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5803
Mailing Address - Country:US
Mailing Address - Phone:216-755-4044
Mailing Address - Fax:330-967-0571
Practice Address - Street 1:23215 COMMERCE PARK STE 318
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5803
Practice Address - Country:US
Practice Address - Phone:216-755-4044
Practice Address - Fax:330-967-0571
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2020-02-06
Deactivation Date:2019-11-20
Deactivation Code:
Reactivation Date:2019-12-17
Provider Licenses
StateLicense IDTaxonomies
OH35.1202222080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology