Provider Demographics
NPI:1255594206
Name:AZEEM, NOMEN (MD)
Entity type:Individual
Prefix:
First Name:NOMEN
Middle Name:
Last Name:AZEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N HABANA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7150
Mailing Address - Country:US
Mailing Address - Phone:813-333-1353
Mailing Address - Fax:813-333-1618
Practice Address - Street 1:9360 BALM RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5104
Practice Address - Country:US
Practice Address - Phone:813-333-1353
Practice Address - Fax:813-333-2383
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122552208VP0014X, 208100000X
DCMD040855208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME122552OtherMEDICAL LICENSE
DCMD040855OtherDC LICENSE
LAMD.206598OtherLA LICENSE
DCMD040855OtherDC LICENSE