Provider Demographics
NPI:1164428777
Name:AZAR, NABIL (MD)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:
Last Name:AZAR
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 1:730 SOM CENTER RD STE 190
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2362
Mailing Address - Country:US
Mailing Address - Phone:440-646-9955
Mailing Address - Fax:440-646-9929
Practice Address - Street 1:730 SOM CENTER RD STE 190
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:OH
Practice Address - Zip Code:44143-2362
Practice Address - Country:US
Practice Address - Phone:440-646-9955
Practice Address - Fax:440-646-9929
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.051962207R00000X
OH051962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02641110OtherFEDERAL BLACK LUNG PROG
OH0402217OtherMETLIFE
OH341040606028OtherCARESOURCE
OHR51962OtherAPEX
OH0613705Medicaid
OH0996955OtherUNITED MINE WORKERS
OH55230OtherQUALCHOICE
OH3410406060OtherTRICARE
OH108900OtherKAISER
OH341040606003OtherTRICARE
OH000000126361OtherANTHEM
OH0402244OtherMETLIFE
OH6513441OtherCIGNA
OH110044297OtherRAILROAD MEDICARE
OH0613705Medicaid
D34031Medicare UPIN