Provider Demographics
NPI:1780755207
Name:SHIREEN, AZIZA (MD)
Entity type:Individual
Prefix:DR
First Name:AZIZA
Middle Name:
Last Name:SHIREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6936 PINE ARBOR DR S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4580
Mailing Address - Country:US
Mailing Address - Phone:651-326-5800
Mailing Address - Fax:651-326-5802
Practice Address - Street 1:6936 PINE ARBOR DR S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4580
Practice Address - Country:US
Practice Address - Phone:651-326-5800
Practice Address - Fax:651-326-5802
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN49235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1780755207Medicaid
MN1780755207Medicare Oscar/Certification
MN1780755207Medicare NSC
MN1780755207Medicaid
MN1780755207Medicare PIN