Provider Demographics
NPI:1568015147
Name:AZADI, HOSSEIN
Entity Type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:AZADI
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 1:1505 53RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4249
Mailing Address - Country:US
Mailing Address - Phone:941-357-7950
Mailing Address - Fax:941-840-1003
Practice Address - Street 1:MSC 09 5040 ,1 UNIVERSITY OF NEW MEXICO MSC10-5550
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-4249
Practice Address - Country:US
Practice Address - Phone:505-925-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2021-0650390200000X
390200000X
FLME161260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM123456OtherUNMH
NMRS-12345OtherUNMH
NMRS-12345Medicaid