Provider Demographics
NPI:1144042474
Name:EASTWEST PRIMARY CARE LLC
Entity type:Organization
Organization Name:EASTWEST PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-299-3100
Mailing Address - Street 1:6789 RIDGE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5635
Mailing Address - Country:US
Mailing Address - Phone:440-299-3100
Mailing Address - Fax:
Practice Address - Street 1:6789 RIDGE RD STE 105
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5635
Practice Address - Country:US
Practice Address - Phone:440-299-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty