Healthcare Provider Details

I. General information

NPI: 1932970019
Provider Name (Legal Business Name): TALIA SIMONE AZIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 NORTHWESTERN HWY
SOUTHFIELD MI
48075-6501
US

IV. Provider business mailing address

2399 E WALTON BLVD
AUBURN HILLS MI
48326-1955
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-7804
  • Fax: 248-483-7868
Mailing address:
  • Phone: 248-275-3870
  • Fax: 248-918-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4251612
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: