Basic Information
| Provider Information | |||||||||
| NPI: | 1558490748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUFAWAD | ||||||||
| FirstName: | SAMI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 74841 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441940924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163836776 | ||||||||
| FaxNumber: | 2163836745 | ||||||||
| Practice Location | |||||||||
| Address1: | 27100 CHARDON RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441431116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408330915 | ||||||||
| FaxNumber: | 4403470930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 35084593 | OH | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.