Provider Demographics
NPI:1972703536
Name:ABDELAZIZ, AMGED ABDELMONIM TAGELSIR (MD)
Entity Type:Individual
Prefix:
First Name:AMGED
Middle Name:ABDELMONIM TAGELSIR
Last Name:ABDELAZIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AMGED
Other - Middle Name:ABDELMONIM TAGELSIR
Other - Last Name:ABDELAZIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3303 S BOND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-1775
Mailing Address - Fax:503-494-4749
Practice Address - Street 1:3303 S BOND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-1775
Practice Address - Fax:503-494-4749
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD212152207R00000X, 207RC0000X, 207RI0011X
MI4301090853207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease