Provider Demographics
NPI:1316052806
Name:F K ABBOUSY MD, INC.
Entity type:Organization
Organization Name:F K ABBOUSY MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FADHIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ABBOUSY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-877-7755
Mailing Address - Street 1:PO BOX 80690
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-833-5530
Mailing Address - Fax:330-833-6085
Practice Address - Street 1:650 S PROSPECT AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632
Practice Address - Country:US
Practice Address - Phone:330-877-7755
Practice Address - Fax:330-877-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0158903Medicaid
OH0158903Medicaid
OH0546263Medicare ID - Type Unspecified