Provider Demographics
NPI:1518197029
Name:PAREDES, AZRAEL
Entity Type:Individual
Prefix:
First Name:AZRAEL
Middle Name:
Last Name:PAREDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 W LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1967
Mailing Address - Country:US
Mailing Address - Phone:248-723-2400
Mailing Address - Fax:248-723-5785
Practice Address - Street 1:1109 W LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1967
Practice Address - Country:US
Practice Address - Phone:248-723-2400
Practice Address - Fax:248-723-5785
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine