Provider Demographics
NPI:1982629515
Name:AZIM, AHSAN (MD)
Entity Type:Individual
Prefix:
First Name:AHSAN
Middle Name:
Last Name:AZIM
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 1:8814 BIG BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1418
Mailing Address - Country:US
Mailing Address - Phone:702-463-8762
Mailing Address - Fax:702-446-6343
Practice Address - Street 1:8814 BIG BLUFF AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1418
Practice Address - Country:US
Practice Address - Phone:702-463-8762
Practice Address - Fax:702-446-6343
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018751Medicaid
H27335Medicare UPIN
NVV101855Medicare PIN