Organization
FATUMA MIDAMBA MD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FATUMA MIDAMBA M.D. (OWNER)
(440) 834-1833
Entity
Organization
Contact information
Practice address
3619 PARK EAST DR, 205 S, BEACHWOOD, OH 44122-4330
(216) 591-0942
(440) 834-1902
Mailing address
PO BOX 24160, LYNDHURST, OH 44124-0160
(216) 233-2527
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35073702M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9361741
MEDICARE GROUP
OH
Enumeration date
07/08/2006
Last updated
09/19/2013
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