Healthcare Provider Details

I. General information

NPI: 1023017720
Provider Name (Legal Business Name): AZEEM QURESHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 WYANDOTTE WOODS BLVD
DUBLIN OH
43016-8661
US

IV. Provider business mailing address

4425 WYANDOTTE WOODS BLVD
DUBLIN OH
43016-8661
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5339
  • Fax: 614-257-5418
Mailing address:
  • Phone: 614-257-5339
  • Fax: 614-257-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number35-076374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: