Healthcare Provider Details

I. General information

NPI: 1922057371
Provider Name (Legal Business Name): AZHAR ASLAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 E LAKE SHORE DR SUITE 103
DECATUR IL
62521-3832
US

IV. Provider business mailing address

1770 E LAKE SHORE DR SUITE 103
DECATUR IL
62521-3832
US

V. Phone/Fax

Practice location:
  • Phone: 217-422-9036
  • Fax: 217-422-9812
Mailing address:
  • Phone: 217-422-9036
  • Fax: 217-422-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD035339L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: