MEDICARE: ROCHESTER FAMILY MEDICINE PC

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	261QU0200X	Urgent Care Clinic/Center	4301089681	MI
2	207Q00000X	Family Medicine Physician	4301089681	MI

General Provider Information

NPI Number	:	1538590583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCHESTER FAMILY MEDICINE PC

Provider Business Mailing Address
First Line	:	1308 W AUBURN RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-4386
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 W AUBURN RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-4386
Country	:	US
Telephone Number	:	248-915-5949
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TAHERA AZHARUDDIN
Credential	:	M.D.
Telephone Number	:	248-915-5949

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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