Provider Demographics
NPI:1588620413
Name:AIZAD, TAZEEM A (MD;)
Entity Type:Individual
Prefix:DR
First Name:TAZEEM
Middle Name:A
Last Name:AIZAD
Suffix:
Gender:M
Credentials:MD;
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1561 W 7000 S
Mailing Address - Street 2:STE # 202
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3556
Mailing Address - Country:US
Mailing Address - Phone:801-569-8344
Mailing Address - Fax:801-569-9150
Practice Address - Street 1:1561 W 7000 S
Practice Address - Street 2:STE # 202
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3556
Practice Address - Country:US
Practice Address - Phone:801-569-8344
Practice Address - Fax:801-569-9150
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2012-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT1757871205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH30736Medicare UPIN