MEDICARE: DR. HOSAN M AZOMANI M.D

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	18728	MS

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	:	1457342388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOSAN M AZOMANI M.D

Provider Business Mailing Address
First Line	:	P O BOX 1735
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38702-1735
Country	:	US
Telephone Number	:	662-334-9915
Fax Number	:	662-334-9740

Provider Business Practice Location Address
First Line	:	313 ARNOLD AVE
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	MS
Zip	:	38701-4712
Country	:	US
Telephone Number	:	662-334-9915
Fax Number	:	662-334-9740

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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