Provider Demographics
NPI:1124399274
Name:AZZARELLI, BIAGIO (MD)
Entity Type:Individual
Prefix:PROF
First Name:BIAGIO
Middle Name:
Last Name:AZZARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6476 DAWSON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-7111
Mailing Address - Country:US
Mailing Address - Phone:317-840-3729
Mailing Address - Fax:
Practice Address - Street 1:6476 DAWSON LAKE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-7111
Practice Address - Country:US
Practice Address - Phone:317-840-3729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029346A174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01029346AOtherPHYSICIAN LICENSE