Healthcare Provider Details

I. General information

NPI: 1932288248
Provider Name (Legal Business Name): ASIF AZEEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EAST PARIS AVE SE STE 8
GRAND RAPIDS MI
49546-8260
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-6230
  • Fax: 616-942-6270
Mailing address:
  • Phone: 313-874-4806
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301057351
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: