Provider Demographics
NPI:1366443343
Name:AZIZ, GHULAM RABBANI (MD)
Entity Type:Individual
Prefix:
First Name:GHULAM
Middle Name:RABBANI
Last Name:AZIZ
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 1:16218 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9449
Mailing Address - Country:US
Mailing Address - Phone:330-382-9355
Mailing Address - Fax:330-382-9448
Practice Address - Street 1:16218 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9449
Practice Address - Country:US
Practice Address - Phone:330-382-9355
Practice Address - Fax:330-382-9448
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35079747A207RC0200X
OHOH35-07-9747A207RS0012X
OHOH37079747A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1408622OtherHIGHMARK BCBS
4348701OtherCIGNA
753020102OtherFLORA HEATLH NETWORK/PPOM
753020102001OtherMOUNTAIN STATE BCBS
90768OtherNATIONWIDE HEALTH PLAN
WV1807927000Medicaid
753020102OtherHEALTH AMERICA/ASSURANCE
753020102OtherFIRST HEALTH
753020102OtherUNICARE
OH2254984Medicaid
5246690OtherAETNA
753020102OtherPRIMARY HEATLH SERVICES
000000218659OtherANTHEM BCBS
753020102OtherUMWA
OHP79747AOtherMOUNTAIN HEALT TRUST
OHAZ4065912Medicare PIN
753020102OtherUMWA
110233707Medicare ID - Type UnspecifiedRRMC
OHTR9320711Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
5246690OtherAETNA
G68209Medicare UPIN