Basic Information
| Provider Information | |||||||||
| NPI: | 1326288564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABUSHAHIN | ||||||||
| FirstName: | LAITH | ||||||||
| MiddleName: | I. | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 ACKERMAN RD STE 2120 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432021559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142936529 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2050 KENNY RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432213502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142936529 | ||||||||
| FaxNumber: | 6142939469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2009 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 40874 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 35.133806 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | 40874 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0289313 | 05 | OH | MEDICAID |