Provider Demographics
NPI:1922473123
Name:ABDULAZEEZ, ANGEL MARIE (IP/HOMEHEALTH/TRANSP)
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:MARIE
Last Name:ABDULAZEEZ
Suffix:
Gender:F
Credentials:IP/HOMEHEALTH/TRANSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 HIGHGATE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-6806
Mailing Address - Country:US
Mailing Address - Phone:614-312-6342
Mailing Address - Fax:614-532-6007
Practice Address - Street 1:4175 HIGHGATE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-6806
Practice Address - Country:US
Practice Address - Phone:614-312-6342
Practice Address - Fax:614-532-6007
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM0143595Medicaid