Provider Demographics
NPI:1548368970
Name:KOUBEISSI, MOHAMAD Z (MD)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:Z
Last Name:KOUBEISSI
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 1:2150 PENNSYLVANIA AVE NW # 9400
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:216-280-9433
Mailing Address - Fax:
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW # 9400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:216-280-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0406232084E0001X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548368970OtherMICHIGAN MEDICAID
OH363721OtherWELLCARE MEDICAID
OH7796867OtherAETNA
OH2679874Medicaid
OH742962OtherBUCKEYE MEDICAID
OH000000216483OtherUNISON
PA1024173330001Medicaid
OHP00440903OtherRAILROAD MEDICARE
OH000000510673OtherANTHEM
OH363721OtherWELLCARE MEDICAID