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Individual
SYED KHAJA AZEEMUDDIN
Active
Individual
SYED KHAJA AZEEMUDDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G1812
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130566603
—
TX
01
—
26500
AMERIGROUP
TX
Enumeration date
08/02/2005
Last updated
04/22/2010
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