Provider Demographics
NPI:1598078826
Name:AZEEM, MOONA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOONA
Middle Name:
Last Name:AZEEM
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 1:1523 EAGLE RIDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1156
Mailing Address - Country:US
Mailing Address - Phone:860-995-5876
Mailing Address - Fax:
Practice Address - Street 1:1523 EAGLE RIDGE RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-1156
Practice Address - Country:US
Practice Address - Phone:860-995-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02037207R00000X
IN01090738A207RC0200X
WAMD60719047207RC0200X
NM390200000X
CODR.0071959207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program