Provider Demographics
NPI:1871960930
Name:ABDELAZIZ, ABDELRAHMAN (MD)
Entity type:Individual
Prefix:
First Name:ABDELRAHMAN
Middle Name:
Last Name:ABDELAZIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25125 DETROIT AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2500
Mailing Address - Country:US
Mailing Address - Phone:216-293-0282
Mailing Address - Fax:440-455-9757
Practice Address - Street 1:25125 DETROIT RD STE 100
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2500
Practice Address - Country:US
Practice Address - Phone:216-293-0282
Practice Address - Fax:440-455-9757
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351356902084P0800X
PAMD4653452084P0800X
NJ25MA117406002084P0800X
DEC7-00058492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.135690OtherMEDICAL LICENSE
OH0347929Medicaid