Healthcare Provider Details

I. General information

NPI: 1235791435
Provider Name (Legal Business Name): SHAZIA AZIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 FAIRMONT BLVD
RAPID CITY SD
57701-7375
US

IV. Provider business mailing address

353 FAIRMONT BLVD
RAPID CITY SD
57701-7375
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-4300
  • Fax: 605-755-0682
Mailing address:
  • Phone: 605-755-4300
  • Fax: 605-755-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18385
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125080578
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: