Healthcare Provider Details

I. General information

NPI: 1326351156
Provider Name (Legal Business Name): QURATULAIN A AZIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 CLYO RD STE A
CENTERVILLE OH
45459-2785
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B2ND
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7300
  • Fax: 937-208-7330
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-208-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301095834
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.133743
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: