Individual
HAZEM M NOURALDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1730 WEST 25TH ST, MAIN FLOOR, CLEVELAND, OH 44113
(216) 522-9100
(216) 696-7375
Mailing address
24651 CENTER RIDGE RD, SUITE 350, WESTLAKE, OH 44145-5635
(440) 895-5056
(440) 333-2935
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35070915N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000202045
ANTHEM
—
01
—
0119204
GROUP MEDICAID
—
01
—
106390
KAISER
—
01
—
10796852
CAQH
—
01
—
110192212
RR MEDICARE INDIVIDUAL
—
01
—
1780634279
GROUP NPI
—
05
—
2026855
—
OH
01
—
34-1783789
GROUP TAX ID
—
01
—
3610861
GROUP ASC MEDICARE
—
01
—
5522585
AETNA
—
01
—
9273172
MEDICARE GROUP NUMBER
—
01
—
CA4511
RR MEDICARE GROUP
—
01
—
D368301
GROUP IND DIAGNOSTICS MED
—
Enumeration date
03/07/2006
Last updated
11/01/2011
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