Provider Demographics
NPI:1841311867
Name:ASHRAF AZEEM, MD LLC
Entity type:Organization
Organization Name:ASHRAF AZEEM, MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDEL-AZEEM
Authorized Official - Suffix:
Authorized Official - Credentials:M
Authorized Official - Phone:303-338-5437
Mailing Address - Street 1:3035 S PARKER RD
Mailing Address - Street 2:# 555
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2926
Mailing Address - Country:US
Mailing Address - Phone:303-338-5437
Mailing Address - Fax:
Practice Address - Street 1:3035 S PARKER RD
Practice Address - Street 2:# 555
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2926
Practice Address - Country:US
Practice Address - Phone:303-338-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34560261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01345602Medicaid
COBA4567511OtherASHRAF ABDEL-AZEEM, MD
=========OtherTIN
CO01345602Medicaid
=========OtherTIN