Muhammad Azam, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

4301064175 Issued in MI

Practice address

1309 Sheldon Rd
Grand Haven, MI 49417-2404

Phone

(616) 847-5200

NPI assigned

Sep 9, 2005

Last updated

Oct 31, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383177600000",
    "number": "1043204696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 SOUTHWYCK BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436141509",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 SHELDON RD",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172404",
            "telephone_number": "616-847-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZAM",
        "first_name": "MUHAMMAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2013-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301064175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4195886",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Matthew Michael Bailey, COTA/L
• Dirk A Bakker, M.D.
• Balance in Life, P.C.
• Balance Therapy Services LLC
• Martha Jane Balk, LPC

• Anatomic Pathology & Clinical Pathology Physician in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Anatomic Pathology & Clinical Pathology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.