Individual
DR. MOHAMED BASHAR MAMLOUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20455 LORAIN RD STE 104B, FAIRVIEW PARK, OH 44126-3529
(440) 356-2715
(440) 356-6978
Mailing address
30701 LORAIN RD STE A, NORTH OLMSTED, OH 44070-6325
(440) 274-5035
(440) 716-8608
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35-038540
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000130207
ANTHEM
OH
05
—
0366698
—
OH
01
—
18958
QUALCHOICE
OH
01
—
2597481
UNITED HEALTHCARE
OH
01
—
264168
FEDERAL BLACK LUNG
OH
01
—
341313510BM
SUMMACARE
OH
01
—
4007588
AETNA
OH
Enumeration date
03/20/2006
Last updated
02/13/2015
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