Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 39 | PA |
NPI | 1104388628 |
---|---|
Provider Name | Ahmed Ismail Kashkoush |
First Address | Cleveland, OH 44195-0001 |
Second Address | Cleveland, OH 44195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 03/04/2019 |