Provider Demographics
NPI:1083342471
Name:AZAM, MUHAMMAD UMAR FAROOQ SR
Entity Type:Individual
Prefix:
First Name:MUHAMMAD UMAR
Middle Name:FAROOQ
Last Name:AZAM
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 76TH ST # 11214
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1259
Mailing Address - Country:US
Mailing Address - Phone:347-330-1565
Mailing Address - Fax:
Practice Address - Street 1:1863 76TH ST # 11214
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1259
Practice Address - Country:US
Practice Address - Phone:347-330-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program