Provider Demographics
NPI:1932288248
Name:AZEEM, ASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
Middle Name:
Last Name:AZEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3405
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3405
Mailing Address - Country:US
Mailing Address - Phone:616-457-9000
Mailing Address - Fax:616-457-3801
Practice Address - Street 1:1200 EAST PARIS AVE SE
Practice Address - Street 2:STE 8
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8260
Practice Address - Country:US
Practice Address - Phone:616-942-6230
Practice Address - Fax:616-942-6270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057351207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104554722Medicaid
MI0P24680003Medicare UPIN
MIE31000Medicare UPIN