Provider Demographics
NPI:1336243989
Name:ABDEL-AZEEM, ASHRAF AM (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:AM
Last Name:ABDEL-AZEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHRAF
Other - Middle Name:
Other - Last Name:AZEEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3035 S PARKER RD
Mailing Address - Street 2:# 555
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2901
Mailing Address - Country:US
Mailing Address - Phone:303-338-5437
Mailing Address - Fax:303-338-0443
Practice Address - Street 1:3035 S PARKER RD
Practice Address - Street 2:# 555
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2901
Practice Address - Country:US
Practice Address - Phone:303-338-5437
Practice Address - Fax:303-338-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34560208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01345602Medicaid
CO34560OtherCO LICENSE
CO34560OtherCO LICENSE
CO01345602Medicaid
BA 4567511OtherDEA