MEDICARE: SHAKEELA AZEEMUDDIN 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	208000000X	Pediatrics Physician	H1549	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27001	OTHER	TX	AMERIGROUP

General Provider Information

NPI Number	:	1750381232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAKEELA AZEEMUDDIN MD

Provider Business Mailing Address
First Line	:	10707 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4748
Country	:	US
Telephone Number	:	281-568-2093
Fax Number	:	281-568-5967

Provider Business Practice Location Address
First Line	:	10707 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4748
Country	:	US
Telephone Number	:	281-568-2093
Fax Number	:	281-568-5967

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	07/08/2007

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Directions to “ SHAKEELA AZEEMUDDIN MD” Practice Location

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