1700020823 NPI number — SHAMEEM AZIZAD M.D.

Table of content: SHAMEEM AZIZAD M.D. (NPI 1700020823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700020823 NPI number — SHAMEEM AZIZAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZIZAD
Provider First Name:
SHAMEEM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700020823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12554 RIATA VISTA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78727-6431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-795-5100
Provider Business Mailing Address Fax Number:
512-795-5122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12554 RIATA VISTA CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78727-6431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-795-5100
Provider Business Practice Location Address Fax Number:
512-795-5122
Provider Enumeration Date:
04/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  P9151 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3382491-05 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3382491-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3382491-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01482138 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P9151 . This is a "TEXAS MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01482139 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 105867900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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