Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 0440173 | KS |
N | 207RA0201X | Internist - Allergy & Immunology | 0440173 | KS |
NPI | 1932543717 |
---|---|
Provider Name | Sara Danielle Azzam |
First Address | Overland Park, KS 66211-1371 |
Second Address | Overland Park, KS 66211-1371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 09/08/2021 |