Basic Information
| Provider Information | |||||||||
| NPI: | 1437154424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEDHKOUR | ||||||||
| FirstName: | AZEDINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3355 GLENDALE AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193833759 | ||||||||
| FaxNumber: | 4193832962 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 MEDICAL PARK STE 508 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042438916 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 35077964 | OH | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 30095 | WV | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2175042 | 05 | OH | MEDICAID |