MEDICARE: NORTHLAND CARDIOLOGY, PA

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		MN

General Provider Information

NPI Number	:	1346345337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND CARDIOLOGY, PA

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	:	PRESIDENT
Name	:	FOUAD GEORGE AZZAM
Credential	:	M.D.
Telephone Number	:	763-531-2030

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/22/2020

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