Provider Demographics
NPI:1518927532
Name:TAKESHIAN, AZITA (MD)
Entity Type:Individual
Prefix:DR
First Name:AZITA
Middle Name:
Last Name:TAKESHIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PILOT MEDIDCAL DRIVE
Mailing Address - Street 2:STE 275
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-380-2205
Mailing Address - Fax:205-380-2206
Practice Address - Street 1:100 PILOT MEDIDCAL DRIVE
Practice Address - Street 2:STE 275
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-380-2205
Practice Address - Fax:205-380-2206
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631096291OtherTAX ID #
AL00085274Medicaid
AL00085274Medicaid
AL000085274Medicare ID - Type UnspecifiedPROVIDER #