Provider Demographics
NPI:1013238609
Name:AZIZUDDIN, ASFIYA T (MD)
Entity Type:Individual
Prefix:
First Name:ASFIYA
Middle Name:T
Last Name:AZIZUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ERIE CT
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2566
Mailing Address - Country:US
Mailing Address - Phone:170-884-8463
Mailing Address - Fax:708-848-4672
Practice Address - Street 1:1 ERIE CT
Practice Address - Street 2:SUITE 4010
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2566
Practice Address - Country:US
Practice Address - Phone:708-848-4630
Practice Address - Fax:708-848-4672
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058562390200000X
IL036130970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program