Healthcare Provider Details

I. General information

NPI: 1750851259
Provider Name (Legal Business Name): PREMIER DOCTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3108
US

IV. Provider business mailing address

PO BOX 45001
WESTLAKE OH
44145-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-522-9100
  • Fax:
Mailing address:
  • Phone: 216-522-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. M. HAZEM NOURALDIN
Title or Position: PHYSICIAN PARTNER
Credential: MD
Phone: 216-522-9100