MEDICARE: IRFAN AZEEM MD

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	207L00000X	Anesthesiology Physician	050978	GA

General Provider Information

NPI Number	:	1346240587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRFAN AZEEM MD

Provider Business Mailing Address
First Line	:	1824 WALTON WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-3804
Country	:	US
Telephone Number	:	706-737-9250
Fax Number	:	706-733-0697

Provider Business Practice Location Address
First Line	:	1350 WALTON WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2612
Country	:	US
Telephone Number	:	706-737-9250
Fax Number	:	706-733-0697

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/03/2011

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