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Individual

DR. AZRIEL AVEZBADALOV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 432-2297
(260) 434-6433
Mailing address
7850 LAGO DEL MAR DR APT 116, BOCA RATON, FL 33433-4984
(646) 671-9252

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
02005736A
IN
207RC0000X
Cardiovascular Disease Physician
267039
NY
207RC0000X
Cardiovascular Disease Physician
34.016578
OH
207RC0000X
Cardiovascular Disease Physician
OS13717
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
018825600
FL
01
260690286
MEDICARE
IN
05
300029932
IN
01
PENDING
MEDICARE
FL
Enumeration date
04/13/2011
Last updated
01/10/2025
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