Provider Demographics
NPI:1457343816
Name:ABDUL-AZIZ, TAMMAM (MD)
Entity Type:Individual
Prefix:
First Name:TAMMAM
Middle Name:
Last Name:ABDUL-AZIZ
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 1:14629 PRAIRIE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551
Mailing Address - Country:US
Mailing Address - Phone:419-690-8698
Mailing Address - Fax:
Practice Address - Street 1:1447 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4727
Practice Address - Country:US
Practice Address - Phone:989-583-7000
Practice Address - Fax:419-697-7726
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082970207L00000X
OH35082201207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5182120Medicaid
OHP00389819OtherRRMC
OH341881145-002OtherMMO
OH000000300038OtherANTHEM
OH04097OtherPARAMOUNT
OH00000049260OtherANTHEM
OH2659341Medicaid
OH7531873OtherAETNA
OHAB7314511Medicare ID - Type Unspecified
OH2659341Medicaid
MI5182120Medicaid
OHAB4186151Medicare PIN