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General NPI Number Information
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NPI Number | 1073583886
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Entity Type | Individual
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Provider Name | MICHAEL P. AZEVEDO MD
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Gender | Male
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 1805 E FIR AVE SUITE 102
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City | FRESNO
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State | CA
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Zip | 93720-3859
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Country | US
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Telephone | 559-325-3070
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Fax | 559-325-3073
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Provider Business Mailing Address
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Address Line | 1805 E FIR AVE SUITE 102
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City | FRESNO
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State | CA
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Zip | 93720-3859
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Country | US
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Telephone | 559-325-3070
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Fax | 559-325-3073
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A66383
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License Number State | CA
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