Healthcare Provider Details

I. General information

NPI: 1083848535
Provider Name (Legal Business Name): AZEEM Z. VASI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W. GRAND AVE. GRANDVIEW HOSPITAL AND MEDICAL CENTER- MEDICAL EDUCATIO
DAYTON OH
45405
US

IV. Provider business mailing address

124 BROWN DR
BRYAN OH
43506-8959
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-3248
  • Fax:
Mailing address:
  • Phone: 419-636-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number58.002750
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: