Healthcare Provider Details

I. General information

NPI: 1861516502
Provider Name (Legal Business Name): PETER AZIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # M41
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

28099 RED RAVEN RD
PEPPER PIKE OH
44124-4551
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-6532
  • Fax:
Mailing address:
  • Phone: 734-717-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35.097437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: