1245206903 NPI number — MOURAD EL-GAZZAR MD

Table of content: MOURAD EL-GAZZAR MD (NPI 1245206903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245206903 NPI number — MOURAD EL-GAZZAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EL-GAZZAR
Provider First Name:
MOURAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245206903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20525 CENTER RIDGE RD
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
ROCKY RIVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-895-5056
Provider Business Mailing Address Fax Number:
440-333-2935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15000 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-227-9964
Provider Business Practice Location Address Fax Number:
216-221-5473
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35057954E , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 108122 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: D368301 . This is a "DIAGNOSTIC MEDICARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3610861 . This is a "ASC MEDICARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 10826651 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341783789089 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5676539 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: CA4511 . This is a "GROUP RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110203792 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000190833 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0947560 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9273172 . This is a "MEDICARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 108122 . This is a "KAISER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1780634279 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: L57954 . This is a "SUMMACARE APEX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9273172 . This is a "GROUP MEDICAID" identifier . This identifiers is of the category "OTHER".




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