Provider Demographics
NPI:1467485276
Name:YEDIDAG, AZADE C (MD)
Entity type:Individual
Prefix:
First Name:AZADE
Middle Name:C
Last Name:YEDIDAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7887 N KENDALL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7494
Mailing Address - Country:US
Mailing Address - Phone:305-273-6266
Mailing Address - Fax:305-273-6520
Practice Address - Street 1:11104 PARKVIEW CIRCLE DR STE 310
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1733
Practice Address - Country:US
Practice Address - Phone:260-266-5230
Practice Address - Fax:260-458-5972
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036087547207RG0100X
IN01097317A207RG0100X
FLME118957207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G15531Medicare UPIN