Provider Demographics
NPI:1538130117
Name:AZIZULLAH, ABU N (MD)
Entity Type:Individual
Prefix:
First Name:ABU
Middle Name:N
Last Name:AZIZULLAH
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 1:8550 NE 138TH LANE
Mailing Address - Street 2:THE OAKS AT 138 BLDG 800
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6816
Mailing Address - Country:US
Mailing Address - Phone:352-391-5299
Mailing Address - Fax:352-391-5308
Practice Address - Street 1:8550 NE 138TH LANE
Practice Address - Street 2:THE OAKS AT 138 BLDG 800
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6816
Practice Address - Country:US
Practice Address - Phone:352-391-5299
Practice Address - Fax:352-391-5308
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43231OtherBCBS
FL271012900Medicaid
FLAF810Medicare PIN
FL271012900Medicaid
FL43231OtherBCBS
FLG98046Medicare UPIN