Healthcare Provider Details

I. General information

NPI: 1508939588
Provider Name (Legal Business Name): SHERIF A AZIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E ELM ST
CARSON CITY MI
48811-9693
US

IV. Provider business mailing address

36300 DEQUINDRE RD APT 108
STERLING HEIGHTS MI
48310-4243
US

V. Phone/Fax

Practice location:
  • Phone: 989-584-3971
  • Fax: 989-584-6734
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301086737
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: