Provider Demographics
NPI:1598388662
Name:MUHAMMAD, AZZAM NASIR
Entity Type:Individual
Prefix:
First Name:AZZAM
Middle Name:NASIR
Last Name:MUHAMMAD
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 1:6591 BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-4808
Mailing Address - Country:US
Mailing Address - Phone:216-210-7230
Mailing Address - Fax:
Practice Address - Street 1:6591 BASSWOOD DR
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-4808
Practice Address - Country:US
Practice Address - Phone:216-210-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400726010308376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide