MEDICARE: DR. BALSAM AZIZ D.D.S.

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	122300000X	Dentist	15277	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	383223640	OTHER	MI	ALL OTHER INSURANCES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336203256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BALSAM AZIZ D.D.S.

Provider Business Mailing Address
First Line	:	2141 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4807
Country	:	US
Telephone Number	:	586-795-5504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4807
Country	:	US
Telephone Number	:	586-795-5504
Fax Number	:

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	07/21/2016

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