Basic Information
| Provider Information | |||||||||
| NPI: | 1821003591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZZOLINI | ||||||||
| FirstName: | SILVIO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 W. LAS COLINAS BLVD | ||||||||
| Address2: | SUITE 2000 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726573000 | ||||||||
| FaxNumber: | 9722360096 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 S STEMMONS FWY | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750674547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723166495 | ||||||||
| FaxNumber: | 9723166500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35745 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | M6509 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2206591-01 | 05 | TX | MEDICAID |