Individual
GASAN NEMR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15000 MADISON AVE, LAKEWOOD, OH 44107
(216) 221-7642
(216) 529-7806
Mailing address
24651 CENTER RIDGE RD, STE 350, WESTLAKE, OH 44145-5627
(440) 895-5056
(440) 333-2935
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35082501N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119204
GROUP MEDICAID
—
01
—
103872
KAISER
—
01
—
11059884
CAQH
—
01
—
1780634279
GROUP NPI
—
05
—
2422373
—
OH
01
—
3610861
GROUP ASC MEDICARE
—
01
—
9273172
GROUP MEDICARE
—
01
—
CA4511
RR MEDICARE GROUP
—
01
—
D368301
GROUP IND DIAGNOSTICS MED
—
01
—
P00035659
RR MEDICARE INDIVIDUAL
—
Enumeration date
03/03/2006
Last updated
07/11/2016
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