Provider Demographics
NPI:1912959909
Name:GITIFOROOZ, HABIBEH (MD)
Entity type:Individual
Prefix:
First Name:HABIBEH
Middle Name:
Last Name:GITIFOROOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 BELLE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4202
Mailing Address - Country:US
Mailing Address - Phone:216-529-2913
Mailing Address - Fax:216-529-2936
Practice Address - Street 1:1450 BELLE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4202
Practice Address - Country:US
Practice Address - Phone:216-529-2913
Practice Address - Fax:216-529-2936
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078025207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH737243OtherBCHP
OH000000362095OtherANTHEM BC/BS
OH341542312111OtherCARESOURCE
OH351252OtherWELLCARE
OHP00315481OtherRRCARE
OH2229127Medicaid
OH4043838Medicare PIN
OH4043837Medicare PIN
OH351252OtherWELLCARE