Healthcare Provider Details

I. General information

NPI: 1124359831
Provider Name (Legal Business Name): MUHAMMAD AZAM KHALID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17815 CLOVER ST
BROWNSTOWN MI
48193-8806
US

IV. Provider business mailing address

17815 CLOVER ST
BROWNSTOWN MI
48193-8806
US

V. Phone/Fax

Practice location:
  • Phone: 734-778-0481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301040458
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: