Provider Demographics
NPI:1417967118
Name:AZEM, HAITHAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:HAITHAM
Middle Name:M
Last Name:AZEM
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:PO BOX 74113
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-4113
Mailing Address - Country:US
Mailing Address - Phone:216-383-6776
Mailing Address - Fax:216-383-6745
Practice Address - Street 1:88 CENTER RD STE 130
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2708
Practice Address - Country:US
Practice Address - Phone:440-232-4455
Practice Address - Fax:440-232-3147
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0726021Medicaid
OH4054092Medicare ID - Type Unspecified
D97913Medicare UPIN