Provider Demographics
NPI:1902078405
Name:AZITA TAKESHIAN MD PC
Entity Type:Organization
Organization Name:AZITA TAKESHIAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-380-2205
Mailing Address - Street 1:100 PILOT MEDICAL DR STE 275
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3475
Mailing Address - Country:US
Mailing Address - Phone:205-380-2205
Mailing Address - Fax:205-380-2206
Practice Address - Street 1:100 PILOT MEDICAL DR STE 275
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3475
Practice Address - Country:US
Practice Address - Phone:205-380-2205
Practice Address - Fax:205-380-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000085274Medicaid
AL000085274Medicaid
ALC74192Medicare UPIN