Healthcare Provider Details

I. General information

NPI: 1669664538
Provider Name (Legal Business Name): GHASSAN E KANAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE DEPT OF
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE DEPT OF
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 216-286-7389
  • Fax:
Mailing address:
  • Phone: 216-286-7389
  • Fax: 216-986-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35055597
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35.055597
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: