Provider Demographics
NPI:1790770337
Name:AZIMPOOR, SHEEREEN LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEEREEN
Middle Name:LAURA
Last Name:AZIMPOOR
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:PO BOX 21249
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40221-0249
Mailing Address - Country:US
Mailing Address - Phone:301-983-0322
Mailing Address - Fax:
Practice Address - Street 1:530 S JACKSON ST # C07
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-852-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00601972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015068S80Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #