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General NPI Number Information
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NPI Number | 1801277181
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Entity Type | Organization
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Legal Business Name | AZITA TAKESHIAN MD
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 1923 COURSON CT
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City | LEEDS
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State | AL
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Zip | 35094-7510
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Country | US
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Telephone | 205-699-1632
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Fax | 866-546-2124
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Provider Business Mailing Address
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Address Line | 100 PILOT MEDICAL DR STE 275
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City | BIRMINGHAM
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State | AL
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Zip | 35235-3411
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Country | US
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Telephone | 205-699-1632
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Fax | 866-546-2124
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Authorized Official
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Title or Position | DOO
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Name | JACKI BAILEY
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Credential |
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Telephone | 205-699-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | AL
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