Provider Demographics
NPI:1720074495
Name:TOUSI, BABAK (MD)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:TOUSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 W 25TH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3108
Mailing Address - Country:US
Mailing Address - Phone:216-363-2319
Mailing Address - Fax:216-363-2356
Practice Address - Street 1:1730 W 25TH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3108
Practice Address - Country:US
Practice Address - Phone:216-363-2319
Practice Address - Fax:216-363-2356
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083489207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000368729OtherANTHEM
OH2580096Medicaid
OH2580096Medicaid
OH4165372Medicare PIN
OH000000368729OtherANTHEM
OHTO4165371Medicare ID - Type Unspecified