Provider Demographics
NPI:1992835656
Name:JAMAL AZEM, M.D., INC
Entity Type:Organization
Organization Name:JAMAL AZEM, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-269-8020
Mailing Address - Street 1:36100 EUCLID AVE
Mailing Address - Street 2:SUITE 330A
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4456
Mailing Address - Country:US
Mailing Address - Phone:440-269-8020
Mailing Address - Fax:440-269-1646
Practice Address - Street 1:36100 EUCLID AVE
Practice Address - Street 2:SUITE 330A
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4456
Practice Address - Country:US
Practice Address - Phone:440-269-8020
Practice Address - Fax:440-269-1646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059071A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2928167Medicaid
OH9287441Medicare PIN
OH2928167Medicaid