Healthcare Provider Details

I. General information

NPI: 1376107268
Provider Name (Legal Business Name): MARIAM AZIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12 AVENUE
MIAMI FL
33136-1668
US

IV. Provider business mailing address

1800 NW 10 AVENUE M-820
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1191
  • Fax:
Mailing address:
  • Phone: 305-585-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberTRN37036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: