Healthcare Provider Details

I. General information

NPI: 1164498879
Provider Name (Legal Business Name): HAYDER M KADHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST STE 3A
CLEVELAND OH
44113
US

IV. Provider business mailing address

24651 CENTER RIDGE RD STE 350
WESTLAKE OH
44145-5627
US

V. Phone/Fax

Practice location:
  • Phone: 216-771-3413
  • Fax: 216-771-5028
Mailing address:
  • Phone: 440-895-5056
  • Fax: 440-895-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35-082640
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number35-082640
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: