Healthcare Provider Details

I. General information

NPI: 1285256339
Provider Name (Legal Business Name): SOFIYA AZIM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12680 OLIVE BLVD STE 100
SAINT LOUIS MO
63141-6322
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-3643
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-8900
  • Fax:
Mailing address:
  • Phone: 314-251-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023020180
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: