MEDICARE: ERUM QAYUM 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	207Q00000X	Family Medicine Physician	35-08-5100	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

General Provider Information

NPI Number	:	1548345267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERUM QAYUM MD

Provider Business Mailing Address
First Line	:	2601 MISSION POINT BLVD
Second Line	:	SUITE 100
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-6600
Country	:	US
Telephone Number	:	937-912-4441
Fax Number	:	937-429-4236

Provider Business Practice Location Address
First Line	:	2880 STELZER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3133
Country	:	US
Telephone Number	:	614-472-2880
Fax Number	:	614-472-2881

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	11/27/2012

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Directions to “ ERUM QAYUM MD” Practice Location

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