Provider Demographics
NPI:1497157705
Name:AZAN MEDICAL, PA
Entity Type:Organization
Organization Name:AZAN MEDICAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-584-8185
Mailing Address - Street 1:PO BOX 110724
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RCH
Mailing Address - State:FL
Mailing Address - Zip Code:34211-0010
Mailing Address - Country:US
Mailing Address - Phone:841-584-8185
Mailing Address - Fax:
Practice Address - Street 1:4014 SAWYER RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1272
Practice Address - Country:US
Practice Address - Phone:841-584-8185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty