Provider Demographics
NPI:1285603027
Name:ALLAM, AZMY A (MD)
Entity type:Individual
Prefix:MR
First Name:AZMY
Middle Name:A
Last Name:ALLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 HEALTH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867
Mailing Address - Country:US
Mailing Address - Phone:989-723-8666
Mailing Address - Fax:989-725-1434
Practice Address - Street 1:200 HEALTH PARK DRIVE
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-723-8666
Practice Address - Fax:989-725-1434
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301054357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11-07800631OtherBC OF MI
MI416467410Medicaid
MI0M86580001Medicare PIN
MI416467410Medicaid