Provider Demographics
NPI:1922253921
Name:TAYYAB, AZAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AZAD
Middle Name:
Last Name:TAYYAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AZAD
Other - Middle Name:M
Other - Last Name:TAYYAB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1120 EASTATE DR.
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-8093
Mailing Address - Country:US
Mailing Address - Phone:217-224-4395
Mailing Address - Fax:
Practice Address - Street 1:1120 EASTATE DR.
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-8093
Practice Address - Country:US
Practice Address - Phone:217-224-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055930207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055930Medicaid
IL036055930Medicaid