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NPI Code Detail

MEDICARE: MOHAMMED TASHFIQUL AZAM

MEDICARE: MOHAMMED TASHFIQUL AZAM
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1497570733
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOHAMMED TASHFIQUL AZAM
Provider Business Mailing Address
First Line : 445 HEALTH SCIENCES BLVD
Second Line :
City : DOTHAN
State : AL
Zip : 36303-6904
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 445 HEALTH SCIENCES BLVD
Second Line :
City : DOTHAN
State : AL
Zip : 36303-6904
Country : US
Telephone Number : 334-699-2266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2024
Last Update Date : 11/21/2024

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Directions to “ MOHAMMED TASHFIQUL AZAM ” Practice Location

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