Provider Demographics
NPI:1609843895
Name:NOURALDIN, HAZEM M (MD)
Entity Type:Individual
Prefix:
First Name:HAZEM
Middle Name:M
Last Name:NOURALDIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24651 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5635
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:1730 WEST 25TH ST
Practice Address - Street 2:MAIN FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113
Practice Address - Country:US
Practice Address - Phone:216-522-9100
Practice Address - Fax:216-696-7375
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-11-01
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Provider Licenses
StateLicense IDTaxonomies
OH35070915N207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3610861OtherGROUP ASC MEDICARE
9273172OtherMEDICARE GROUP NUMBER
000000202045OtherANTHEM
106390OtherKAISER
110192212OtherRR MEDICARE INDIVIDUAL
5522585OtherAETNA
D368301OtherGROUP IND DIAGNOSTICS MED
10796852OtherCAQH
34-1783789OtherGROUP TAX ID
0119204OtherGROUP MEDICAID
1780634279OtherGROUP NPI
OH2026855Medicaid
CA4511OtherRR MEDICARE GROUP
9273172OtherMEDICARE GROUP NUMBER
G50702Medicare UPIN