MEDICARE: SYED KHAJA AZEEMUDDIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G1812	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26500	OTHER	TX	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184625097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED KHAJA AZEEMUDDIN MD

Provider Business Mailing Address
First Line	:	10707 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4748
Country	:	US
Telephone Number	:	281-568-2093
Fax Number	:	281-598-7008

Provider Business Practice Location Address
First Line	:	10707 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4748
Country	:	US
Telephone Number	:	281-568-2093
Fax Number	:	281-568-5967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/22/2010

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