Basic Information
| Provider Information | |||||||||
| NPI: | 1164498879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KADHIM | ||||||||
| FirstName: | HAYDER | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24651 CENTER RIDGE RD STE 350 | ||||||||
| Address2: | |||||||||
| City: | WESTLAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441455627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4408955050 | ||||||||
| Practice Location | |||||||||
| Address1: | 1730 W 25TH ST | ||||||||
| Address2: | STE 3A | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167713413 | ||||||||
| FaxNumber: | 2167715028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 06/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084V0102X | 35-082640 | OH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology | 2084N0400X | 35-082640 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 000000286913 | 01 | ANTHEM | OTHER | F82640 | 01 | SUMMACARE APEX | OTHER | 103878 | 01 | KAISER | OTHER | P00077122 | 01 | RR MEDICARE INDIVIDUAL | OTHER | 1780634279 | 01 | GROUP NPI | OTHER | 341783789102 | 01 | CARESOURCE | OTHER | 9273172 | 01 | GROUP MEDICARE | OTHER | 10909331 | 01 | CAQH | OTHER | 2406337 | 05 | OH | MEDICAID | 3610861 | 01 | GROUP ASC MEDICARE | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 7947510 | 01 | AETNA | OTHER | CA4511 | 01 | RR MEDICARE GROUP | OTHER | D368301 | 01 | GROUP IND DIAGNOSTICS MED | OTHER |