Healthcare Provider Details

I. General information

NPI: 1811946478
Provider Name (Legal Business Name): KHAWAJA AZIMUDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 CYPRESS STATION DR SUITE G3
HOUSTON TX
77090-3054
US

IV. Provider business mailing address

1125 CYPRESS STATION DR SUITE G3
HOUSTON TX
77090-3054
US

V. Phone/Fax

Practice location:
  • Phone: 281-583-1300
  • Fax: 281-583-1303
Mailing address:
  • Phone: 281-583-1300
  • Fax: 281-583-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM1012
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: