Provider Demographics
NPI:1144688854
Name:AZZAM, HUSSEIN (MD)
Entity type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:
Last Name:AZZAM
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 1:46325 W 12 MILE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2460
Mailing Address - Country:US
Mailing Address - Phone:248-347-8121
Mailing Address - Fax:248-305-6254
Practice Address - Street 1:46325 W 12 MILE RD STE 215
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-347-8121
Practice Address - Fax:248-305-6254
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056937208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics