MEDICARE: TAMMAM ABDUL-AZIZ 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	207L00000X	Anesthesiology Physician	4301082970	MI
2	207L00000X	Anesthesiology Physician	35082201	OH

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
2	P00389819	OTHER	OH	RRMC
3	341881145-002	OTHER	OH	MMO
4	000000300038	OTHER	OH	ANTHEM
5	04097	OTHER	OH	PARAMOUNT
6	00000049260	OTHER	OH	ANTHEM
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	7531873	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1457343816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMAM ABDUL-AZIZ MD

Provider Business Mailing Address
First Line	:	14629 PRAIRIE LAKE DR
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551
Country	:	US
Telephone Number	:	419-690-8698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1447 N HARRISON ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48602-4727
Country	:	US
Telephone Number	:	989-583-7000
Fax Number	:	419-697-7726

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	03/27/2021

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