Basic Information
Provider Information
NPI: 1417302498
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AZEEZ
FirstName: NADEEM
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 350 N CLARK ST FL 6
Address2:  
City: CHICAGO
State: IL
PostalCode: 606544712
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 6428 GEORGIA AVE NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200122910
CountryCode: US
TelephoneNumber: 2027230303
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/27/2016
LastUpdateDate: 06/28/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDEN1001638DCY Dental ProvidersDentist 

No ID Information.


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