Provider Demographics
NPI:1396885646
Name:AZEEM, MUHAMMAD WAQAR (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:WAQAR
Last Name:AZEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13916 GRAND OAKS CT
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-7932
Mailing Address - Country:US
Mailing Address - Phone:218-330-1345
Mailing Address - Fax:218-825-2182
Practice Address - Street 1:11705 STATE AVE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-7307
Practice Address - Country:US
Practice Address - Phone:218-330-1345
Practice Address - Fax:218-825-2182
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN406322084P0804X
CAA718332084P0804X
MA2049682084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry