Provider Demographics
NPI:1265510515
Name:AZIZ, BASIT (MD)
Entity Type:Individual
Prefix:DR
First Name:BASIT
Middle Name:
Last Name:AZIZ
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 1:919 W MAIN ST
Mailing Address - Street 2:L5
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2832
Mailing Address - Country:US
Mailing Address - Phone:615-264-0063
Mailing Address - Fax:615-264-0035
Practice Address - Street 1:919 W MAIN ST
Practice Address - Street 2:L5
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2832
Practice Address - Country:US
Practice Address - Phone:615-264-0063
Practice Address - Fax:615-264-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN201297280OtherTAX ID
TN3891618Medicaid
TN3891618Medicaid
TN3891618Medicare PIN
TN38916181Medicare PIN