Organization
LAKE ENT INC
Active
Other names
Khalil Azem MD
Organization subpart
No
Provider details
NPI number
Authorized official
KHALIL AZEM MD (PRESIDENT)
(440) 942-9308
Entity
Organization
Contact information
Practice address
36100 EUCLID AVE, #350, WILLOUGHBY, OH 44094-4456
(440) 942-9308
(440) 942-8981
Mailing address
36100 EUCLID AVE, #350, WILLOUGHBY, OH 44094-4456
(440) 942-9308
(440) 942-8981
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
054514
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000131755
BLUE CROSS BLUE SHIELD
OH
05
—
0652575
—
OH
01
—
351443601003
MEDICAL MUTUAL
OH
Enumeration date
05/17/2007
Last updated
08/22/2020
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