Provider Demographics
NPI:1942290754
Name:AZIZ, ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:AZIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 WASHINGTON ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4983
Mailing Address - Country:US
Mailing Address - Phone:847-662-1112
Mailing Address - Fax:847-662-1239
Practice Address - Street 1:2504 WASHINGTON ST
Practice Address - Street 2:SUITE 601
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4983
Practice Address - Country:US
Practice Address - Phone:847-662-1112
Practice Address - Fax:847-662-1239
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04900953OtherBCBS PROVIDER NUMBER
IL04900953OtherBCBS PROVIDER NUMBER
C38101Medicare UPIN