Provider Demographics
NPI:1285687202
Name:BARAZANJI, MAJED WALEED (MD)
Entity Type:Individual
Prefix:
First Name:MAJED
Middle Name:WALEED
Last Name:BARAZANJI
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:PO BOX 71602
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-0602
Mailing Address - Country:US
Mailing Address - Phone:515-243-2057
Mailing Address - Fax:515-244-5570
Practice Address - Street 1:1701 22ND ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1443
Practice Address - Country:US
Practice Address - Phone:515-440-6622
Practice Address - Fax:515-440-6698
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2063693Medicaid
IAE57954Medicare UPIN
IA2063693Medicaid
IAI15282Medicare PIN