Individual
HUMZA SHAHID AZAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1010 RANCH ROAD 620 S STE 107, LAKEWAY, TX 78734-5638
(512) 233-4606
Mailing address
2200 E WASHINGTON ST, BLOOMINGTON, IL 61701-4364
(309) 665-5755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101019538
IL
Other
Enumeration date
06/23/2011
Last updated
08/16/2021
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