Provider Demographics
NPI:1174714307
Name:TAREK ELSAWY, M.D., LLC
Entity type:Organization
Organization Name:TAREK ELSAWY, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-543-9810
Mailing Address - Street 1:275 SPRINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4548
Mailing Address - Country:US
Mailing Address - Phone:330-670-5316
Mailing Address - Fax:866-211-7728
Practice Address - Street 1:5555 TRANSPORTATION BLVD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5371
Practice Address - Country:US
Practice Address - Phone:440-543-9810
Practice Address - Fax:440-543-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0417906Medicaid
OHF95608Medicare UPIN
OH0417906Medicaid
OHSP00272Medicare PIN