Provider Demographics
NPI:1497784284
Name:AZAD, SALEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:SALEEM
Middle Name:
Last Name:AZAD
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 1:4491 VENOY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2530
Mailing Address - Country:US
Mailing Address - Phone:734-326-5030
Mailing Address - Fax:
Practice Address - Street 1:4491 VENOY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2530
Practice Address - Country:US
Practice Address - Phone:734-326-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010356772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4330022Medicaid
MI121583OtherGREAT LAKES HEALTH PLAN
MI121583OtherGREAT LAKES HEALTH PLAN