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Individual

IBRAHIM BSHARA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3665 W 117TH ST, CLEVELAND, OH 44111-5215
(216) 351-0778
(216) 251-5963
Mailing address
20525 CENTER RIDGE RD, SUITE 220, ROCKY RIVER, OH 44116
(440) 895-5056
(440) 333-2935

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35063037B
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000031825
ANTHEM
OH
01
0119204
GROUP MEDICAID
05
0874362
OH
01
10789186
CAQH
01
109285
KAISER
01
110099557
RR MEDICARE INDIVIDUAL
01
1780634279
GROUP NPI
01
3610861
GROUP ASC MEDICARE
01
9273172
GROUP MEDICARE
01
CA4511
GROUP RR MEDICARE
01
D368301
GROUP IND DIAGNOSTICS MED
Enumeration date
02/23/2006
Last updated
09/29/2009
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