Provider Demographics
NPI:1902889942
Name:AJALA, MUSA A (MD)
Entity type:Individual
Prefix:
First Name:MUSA
Middle Name:A
Last Name:AJALA
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 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4299
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:1717 MEDICAL BLVD
Practice Address - Street 2:STE B
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1239
Practice Address - Country:US
Practice Address - Phone:419-425-8000
Practice Address - Fax:419-425-8025
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078983174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000267351OtherANTHEM
OH5444547OtherAETNA
OH2222400Medicaid
OH390008498OtherRAILROAD MEDICARE
OHG55294Medicare UPIN
OH2222400Medicaid