Provider Demographics
NPI:1073662888
Name:AZIEM, SAIYYED OOMER (DO)
Entity Type:Individual
Prefix:DR
First Name:SAIYYED
Middle Name:OOMER
Last Name:AZIEM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-526-3005
Mailing Address - Fax:336-526-3011
Practice Address - Street 1:100 JOHNSON RIDGE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2400
Practice Address - Country:US
Practice Address - Phone:336-526-3005
Practice Address - Fax:336-526-3011
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238246207R00000X
NC2013-02035207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine