Basic Information
| Provider Information | |||||||||
| NPI: | 1932288248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZEEM | ||||||||
| FirstName: | ASIF | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3405 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477333405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164579000 | ||||||||
| FaxNumber: | 6164573801 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 EAST PARIS AVE SE | ||||||||
| Address2: | STE 8 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495468260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169426230 | ||||||||
| FaxNumber: | 6169426270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 05/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 4301057351 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 104554722 | 05 | MI | MEDICAID |