Provider Demographics
NPI:1457342388
Name:AZOMANI, HOSAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:HOSAN
Middle Name:M
Last Name:AZOMANI
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:P O BOX 1735
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38702-1735
Mailing Address - Country:US
Mailing Address - Phone:662-334-9915
Mailing Address - Fax:662-334-9740
Practice Address - Street 1:313 ARNOLD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4712
Practice Address - Country:US
Practice Address - Phone:662-334-9915
Practice Address - Fax:662-334-9740
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18728208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02933236Medicaid
I23239Medicare UPIN