Provider Demographics
NPI:1316976483
Name:TAGHIZADEH, TOURAJ (MD)
Entity type:Individual
Prefix:
First Name:TOURAJ
Middle Name:
Last Name:TAGHIZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7255 OLD OAK BLVD
Mailing Address - Street 2:C208
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3329
Mailing Address - Country:US
Mailing Address - Phone:440-816-2708
Mailing Address - Fax:440-243-8480
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:C208
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-816-2708
Practice Address - Fax:440-243-8480
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35074563207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000132618OtherANTHEM BLUE CROSS/BLUE SH
OH417130001OtherCARESOURCE
OH341487428OtherTAX ID
OH100653OtherKAISER
OH060051346OtherRAILROAD MEDICARE
OHP74563OtherSUMMACARE
OH5279647OtherAETNA
OH2093390Medicaid
OH2501674OtherUNITED HEALTHCARE
OH86797OtherQUALCHOICE
OH100653OtherKAISER
OH2093390Medicaid