Basic Information
| Provider Information | |||||||||
| NPI: | 1457343816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDUL-AZIZ | ||||||||
| FirstName: | TAMMAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14629 PRAIRIE LAKE DR | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196908698 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1447 N HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895837000 | ||||||||
| FaxNumber: | 4196977726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 03/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4301082970 | MI | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35082201 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 5182120 | 05 | MI | MEDICAID | P00389819 | 01 | OH | RRMC | OTHER | 341881145-002 | 01 | OH | MMO | OTHER | 000000300038 | 01 | OH | ANTHEM | OTHER | 04097 | 01 | OH | PARAMOUNT | OTHER | 00000049260 | 01 | OH | ANTHEM | OTHER | 2659341 | 05 | OH | MEDICAID | 7531873 | 01 | OH | AETNA | OTHER |