Provider Demographics
NPI:1033185830
Name:AZZAM, FOUAD GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:FOUAD
Middle Name:GEORGE
Last Name:AZZAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7101 NORTHLAND CIR N
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1517
Mailing Address - Country:US
Mailing Address - Phone:763-531-2030
Mailing Address - Fax:763-531-2099
Practice Address - Street 1:7101 NORTHLAND CIR N
Practice Address - Street 2:SUITE 209
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1517
Practice Address - Country:US
Practice Address - Phone:763-531-2030
Practice Address - Fax:763-531-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20093207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN067568700Medicaid
MNB58416Medicare UPIN
MN067568700Medicaid