Healthcare Provider Details

I. General information

NPI: 1790958452
Provider Name (Legal Business Name): MICHAEL B AZARKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N BROADWAY AVE # 215
REDONDO BEACH CA
90277
US

IV. Provider business mailing address

319 N BROADWAY APT 215
REDONDO BEACH CA
90277-2850
US

V. Phone/Fax

Practice location:
  • Phone: 310-408-7096
  • Fax:
Mailing address:
  • Phone: 310-408-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA116986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2010-0711
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD443263
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD443263
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA116986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: