Provider Demographics
NPI:1750381232
Name:AZEEMUDDIN, SHAKEELA (MD)
Entity type:Individual
Prefix:
First Name:SHAKEELA
Middle Name:
Last Name:AZEEMUDDIN
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 1:10707 W BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4748
Mailing Address - Country:US
Mailing Address - Phone:281-568-2093
Mailing Address - Fax:281-568-5967
Practice Address - Street 1:10707 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4748
Practice Address - Country:US
Practice Address - Phone:281-568-2093
Practice Address - Fax:281-568-5967
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1549208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27001OtherAMERIGROUP
00A87CMedicare ID - Type Unspecified
B21035Medicare UPIN