Provider Demographics
NPI:1154423887
Name:REZAEE, ROD (MD)
Entity type:Individual
Prefix:
First Name:ROD
Middle Name:
Last Name:REZAEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073033207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000503674OtherANTHEM
IN200873460OtherIN MEDICAID
OH352796OtherWELLCARE
OHP00353695OtherRAILROAD MEDICARE
OH000000221167OtherUNISON
OH739244OtherBUCKEYE
MI1154423887Medicaid
OH2183122Medicaid
OH2183122OtherBCMH
OH7457359OtherAETNA
OH352796OtherWELLCARE
OH739244OtherBUCKEYE