Individual
BASEL MOUSSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20997 LORAIN RD, FAIRVIEW PARK, OH 44176
(440) 356-6666
(440) 356-6651
Mailing address
PO BOX 450615, WEST LAKE, OH 44145
(440) 356-6666
(440) 356-6651
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35-071087
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000152232
ANTHEM BLUE CROSS
OH
05
—
0852635
—
OH
01
—
522125821
PROVIDER NUMBER
OH
01
—
522125821026
CARESOURCE
OH
Enumeration date
08/31/2006
Last updated
09/07/2007
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