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General NPI Number Information
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NPI Number | 1679574156
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Entity Type | Organization
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Legal Business Name | WEST SIDE CARDIOTHORACIC SURGEONS, INC.
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15644 MADISON AVE SUITE #202
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City | LAKEWOOD
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State | OH
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Zip | 44107-5622
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Country | US
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Telephone | 216-521-3384
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Fax | 216-521-3385
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Provider Business Mailing Address
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Address Line | PO BOX 567
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-0567
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Country | US
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Telephone | 216-464-5160
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Fax | 216-464-5982
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. M. HANI KHADDAM
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Credential | M.D.
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Telephone | 216-521-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State | OH
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