MEDICARE: AZRAEL PAREDES

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	207Q00000X	Family Medicine Physician	4301094424	MI

General Provider Information

NPI Number	:	1518197029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZRAEL PAREDES

Provider Business Mailing Address
First Line	:	1109 W LONG LAKE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1967
Country	:	US
Telephone Number	:	248-723-2400
Fax Number	:	248-723-5785

Provider Business Practice Location Address
First Line	:	1109 W LONG LAKE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1967
Country	:	US
Telephone Number	:	248-723-2400
Fax Number	:	248-723-5785

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

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	12/19/2012

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Directions to “ AZRAEL PAREDES ” Practice Location

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