Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 036111490 | IL |
Y | 207T00000X | Neurosurgeon | C135229 | CA |
N | 207T00000X | Neurosurgeon | N0619 | TX |
NPI | 1083870497 |
---|---|
Provider Name | Syed Shabaz Azeem |
First Address | Seattle, WA 98112-5211 |
Second Address | Seattle, WA 98112-5211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2008 |
Last Update Date | 01/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03611490 | (05) | IL |
196952901 | (05) | TX |
206147 | MEDICARE PTAN (GROUP) (01) | IL |
206147137 | MEDICARE PTAN (INDIVIDUAL) (01) | IL |
P01144158 | RAILROAD MEDICARE INDIVIDUAL PTAN (01) | IL |