Provider Demographics
NPI:1184625097
Name:AZEEMUDDIN, SYED KHAJA (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:KHAJA
Last Name:AZEEMUDDIN
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 1:10707 W BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4748
Mailing Address - Country:US
Mailing Address - Phone:281-568-2093
Mailing Address - Fax:281-598-7008
Practice Address - Street 1:10707 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4748
Practice Address - Country:US
Practice Address - Phone:281-568-2093
Practice Address - Fax:281-568-5967
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1812208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26500OtherAMERIGROUP
TX130566603Medicaid
B21036Medicare UPIN
TX130566603Medicaid