Provider Demographics
NPI:1033101977
Name:DIGESTIVE DISEASES SPECIALISTS PC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASES SPECIALISTS PC
Other - Org Name:DR ASIF AZEEM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-942-6230
Mailing Address - Street 1:PO BOX 3405
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3405
Mailing Address - Country:US
Mailing Address - Phone:616-457-9000
Mailing Address - Fax:616-457-3801
Practice Address - Street 1:1200 EAST PARIS AVE SE
Practice Address - Street 2:STE 8
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8260
Practice Address - Country:US
Practice Address - Phone:616-942-6230
Practice Address - Fax:616-942-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00083034OtherRR MEDICARE
MI1004112961OtherBC/BS
MI104554722Medicaid
E31000Medicare UPIN
P00083034OtherRR MEDICARE