Provider Demographics
NPI:1992739528
Name:HIJAZ, ADONIS KHEZAEE (MD)
Entity type:Individual
Prefix:
First Name:ADONIS
Middle Name:KHEZAEE
Last Name:HIJAZ
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 AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-5661
Practice Address - Fax:216-844-1900
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003255208800000X
OH35-086418208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000207093OtherUNISON
OH7250789OtherAETNA
OH000000382823OtherANTHEM
OH2612319Medicaid
OH363637OtherWELLCARE
OH741847OtherBUCKEYE
OH000000516258OtherANTHEM
OHP00412333OtherMEDICARE RAILROAD
OHP00412333OtherRAILROAD MEDICARE
OHHI4172783Medicare PIN
OH000000207093OtherUNISON
OH000000382823OtherANTHEM
OH363637OtherWELLCARE