Provider Demographics
NPI:1245680065
Name:YAZDI, SIAMAK MOHAMMAD ZAKI (MD)
Entity type:Individual
Prefix:DR
First Name:SIAMAK
Middle Name:MOHAMMAD ZAKI
Last Name:YAZDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIAMAK MOHAMMAD
Other - Middle Name:ZAKI RISMANCHI
Other - Last Name:YAZDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1700 6TH AVE S # 9380
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1802
Mailing Address - Country:US
Mailing Address - Phone:205-934-4680
Mailing Address - Fax:
Practice Address - Street 1:1700 6TH AVE S # WIC9380
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1802
Practice Address - Country:US
Practice Address - Phone:205-934-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.40433208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics