MEDICARE: SYED T AZAM 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	207R00000X	Internal Medicine Physician	31208	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225024573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED T AZAM MD

Provider Business Mailing Address
First Line	:	13180 E COLOSSAL CAVE RD
Second Line	:	SUITE 150
City	:	VAIL
State	:	AZ
Zip	:	85641-9794
Country	:	US
Telephone Number	:	520-762-1557
Fax Number	:	520-762-8019

Provider Business Practice Location Address
First Line	:	13180 E COLOSSAL CAVE RD
Second Line	:	SUITE 150
City	:	VAIL
State	:	AZ
Zip	:	85641-9794
Country	:	US
Telephone Number	:	520-762-1557
Fax Number	:	520-762-8019

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	11/03/2011

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