Individual
MOURAD EL-GAZZAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15000 MADISON AVE, LAKEWOOD, OH 44107
(216) 227-9964
(216) 221-5473
Mailing address
20525 CENTER RIDGE RD, STE 220, ROCKY RIVER, OH 44116
(440) 895-5056
(440) 333-2935
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35057954E
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000190833
ANTHEM
—
05
—
0947560
—
OH
01
—
108122
KAISER
OH
01
—
108122
KAISER
—
01
—
10826651
CAQH
—
01
—
110203792
RAILROAD MEDICARE
OH
01
—
1780634279
GROUP NPI
—
01
—
341783789089
CARESOURCE
—
01
—
3610861
ASC MEDICARE GROUP
OH
01
—
5676539
AETNA
OH
01
—
9273172
MEDICARE GROUP
OH
01
—
9273172
GROUP MEDICAID
—
01
—
CA4511
GROUP RR MEDICARE
—
01
—
D368301
DIAGNOSTIC MEDICARE GROUP
OH
01
—
L57954
SUMMACARE APEX
—
Enumeration date
02/23/2006
Last updated
07/22/2014
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