MEDICARE: DR. FOUAD GEORGE AZZAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	20093	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033185830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FOUAD GEORGE AZZAM M.D.

Provider Business Mailing Address
First Line	:	7101 NORTHLAND CIR N
Second Line	:	SUITE 209
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-1517
Country	:	US
Telephone Number	:	763-531-2030
Fax Number	:	763-531-2099

Provider Business Practice Location Address
First Line	:	7101 NORTHLAND CIR N
Second Line	:	SUITE 209
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-1517
Country	:	US
Telephone Number	:	763-531-2030
Fax Number	:	763-531-2099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/03/2010

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