Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 01050846 | IN |
Y | 2080P0203X | Pediatric Critical Care Doctor | 35076200 | OH |
NPI | 1083749998 |
---|---|
Provider Name | Khaled K. Bshesh |
First Address | Toledo, OH 43608-2603 |
Second Address | Toledo, OH 43608-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 09/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20041130 | (05) | IN |
200417730 | (05) | IN |
64064488 | (05) | KY |
H50390 | (02) |