Provider Demographics
NPI:1649280827
Name:AZIMI-ZAVAREI, MINOUDOKHT (MD)
Entity type:Individual
Prefix:
First Name:MINOUDOKHT
Middle Name:
Last Name:AZIMI-ZAVAREI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S SUNNY SLOPE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-7060
Mailing Address - Country:US
Mailing Address - Phone:262-798-8750
Mailing Address - Fax:
Practice Address - Street 1:1350 S SUNNY SLOPE RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-7060
Practice Address - Country:US
Practice Address - Phone:262-798-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43879-20207R00000X
WI43879207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34389100Medicaid
H88373Medicare UPIN