MEDICARE: AZZAM NASIR MUHAMMAD

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	376K00000X	Nurse's Aide	400726010308	OH

General Provider Information

NPI Number	:	1598388662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZZAM NASIR MUHAMMAD

Provider Business Mailing Address
First Line	:	6591 BASSWOOD DR
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-4808
Country	:	US
Telephone Number	:	216-210-7230
Fax Number	:

Provider Business Practice Location Address
First Line	:	6591 BASSWOOD DR
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-4808
Country	:	US
Telephone Number	:	216-210-7230
Fax Number	:

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

Provider Enumeration Date	:	05/24/2020
Last Update Date	:	05/24/2020

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