Basic Information
| Provider Information | |||||||||
| NPI: | 1609843895 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOURALDIN | ||||||||
| FirstName: | HAZEM | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24651 CENTER RIDGE RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | WESTLAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441455635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 1730 WEST 25TH ST | ||||||||
| Address2: | MAIN FLOOR | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165229100 | ||||||||
| FaxNumber: | 2166967375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 11/01/2011 | ||||||||
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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 | 207R00000X | 35070915N | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3610861 | 01 | GROUP ASC MEDICARE | OTHER | 9273172 | 01 | MEDICARE GROUP NUMBER | OTHER | 000000202045 | 01 | ANTHEM | OTHER | 106390 | 01 | KAISER | OTHER | 110192212 | 01 | RR MEDICARE INDIVIDUAL | OTHER | 5522585 | 01 | AETNA | OTHER | D368301 | 01 | GROUP IND DIAGNOSTICS MED | OTHER | 10796852 | 01 | CAQH | OTHER | 34-1783789 | 01 | GROUP TAX ID | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 1780634279 | 01 | GROUP NPI | OTHER | 2026855 | 05 | OH | MEDICAID | CA4511 | 01 | RR MEDICARE GROUP | OTHER |