Provider Demographics
NPI:1275947392
Name:AZAM, MOHAMMED (DO)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:AZAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 TEAROSE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3760
Mailing Address - Country:US
Mailing Address - Phone:630-930-0776
Mailing Address - Fax:
Practice Address - Street 1:3204 TEAROSE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3760
Practice Address - Country:US
Practice Address - Phone:630-930-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021280207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine