KHALID AZZAM (NPI# 1811128416) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811128416 |
| Entity Type | Individual |
| Full Name | KHALID AZZAM |
| Credential | M.D. |
| Practice Address |
435 Phalen Blvd Saint Paul MN 55130 |
| Mailing Address |
8170 33rd Ave Ms 21110q Bloomington MN 55425-4516 |
| Practice Telephone | 6512548379 |
| Practice Fax Number | 6512548300 |
| Mailing Telephone | 6512548739 |
| Mailing Fax Number | 6512548300 |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2019-10-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | 65384 | MN | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 01075391A | IN | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 6172 | NE | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201319820 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 13100 E 136th St, Ste 2000, Fishers, IN 460379440 | 3176885980 | 3176783222 |
| Street Address |
435 PHALEN BLVD |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740720812 | Nicole Renee Hoisser | Nurse Practitioner | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2017-03-08 |
| 1922548809 | Amy Jo Porter | Specialist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2017-02-27 |
| 1285186619 | Katherine Jonas | Physician Assistant | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-11-02 |
| 1316491970 | Angela Kezar | Occupational Therapist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-08-11 |
| 1760833446 | Marie-pier Winters | Physical Therapist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-06-24 |
| 1376904698 | Michaelen Elise Sundstrom | Physical Therapist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-03-14 |
| 1932568524 | Lindsay Knight | Specialist/Technologist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-02-11 |
| 1134594310 | Dawn Babcock | Nurse Practitioner | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2015-12-14 |
| 1750767158 | Leonardo E Candelario Perez | Psychologist | 435 Phalen Blvd, Saint Paul, MN 55130 | 2015-08-07 |
| 1487030490 | Clinton Mccullough | Specialist/Technologist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2015-08-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164904587 | Confident Care LLC | In Home Supportive Care | 1040 Arkwright Street, Saint Paul, MN 55130 | 2018-09-01 |
| 1881015253 | Lucas Bosco Wanga | Psychologist | 715 Edgerton Street, Merrick Community Services, St. Paul, MN 55130 | 2014-01-02 |
| 1174865570 | Sarang Patel | Internal Medicine | 401 Phalen Blvd # 41103d, Saint Paul, MN 55130 | 2013-03-23 |
| 1427394501 | Zongxee Lee | Registered Nurse | 1072 Payne Ave, St. Paul, MN 55130 | 2012-12-18 |
| 1740532753 | One Stop Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 1049 Payne Ave Suite C, St Paul, MN 55130 | 2012-10-15 |
| 1689923997 | Alexis Simmons | Counselor | 402 University Ave East, Suite A-127, Saint Paul, MN 55130 | 2012-08-31 |
| 1689804064 | Group Health Plan, Inc. | Durable Medical Equipment & Medical Supplies | 537 Phalen Blvd, Saint Paul, MN 55130 | 2009-07-21 |
| 1477756534 | Chad Everett Christensen | Chiropractor | 1073 Payne Ave, Saint Paul, MN 55130 | 2007-06-07 |
| 1922219021 | Qwik Urgent Care Clinic | Family Medicine | 1239 Payne Avenue, Saint Paul, MN 55130 | 2007-05-24 |
| 1275743981 | Yia Vang | Technician | 1100 Arkwright St., St. Paul, MN 55130 | 2007-05-23 |
| Find all providers in zip 55130 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861712861 | Wayne William Thompson | Orthopaedic Surgery | 1651 Saunders Ave, Saint Paul, MN 55116-2430 | 2010-06-02 |
| 1154555886 | Richard J Ivance | Orthopaedic Surgery | 2370 Dianna Ln, Saint Paul, MN 55117-1616 | 2009-05-09 |
| 1508873860 | Jeffrey Anthony Furmanek | Orthopaedic Surgery | 17 Exchange St W Ste 307, Saint Paul, MN 55102-1223 | 2006-08-01 |
| 1487623278 | Hanbyul William Park | Orthopaedic Surgery | 280 Smith Ave N Ste 500, Suite 307, Saint Paul, MN 55102-2463 | 2006-03-15 |
| 1053303156 | David J Zaleske | Orthopaedic Surgery | 310 Smith Ave N, Suite 120, Childrens Specialty Clinic-orthopaedics-stpl, Saint Paul, MN 55102-2393 | 2005-08-16 |
| 1144843343 | Smitha Elizabeth Mathew | Orthopaedic Surgery | 200 University Ave E, Saint Paul, MN 55101-2507 | 2020-05-21 |
| 1497142194 | Andrew Thomas Mills | Orthopaedic Surgery | 640 Jackson St, Saint Paul, MN 55101-2502 | 2015-04-20 |
| 1700270634 | Albert V George | Orthopaedic Surgery | 640 Jackson St, Saint Paul, MN 55101-2502 | 2015-03-28 |
| 1629495981 | Kurt Madzunovic | Orthopaedic Surgery | 640 Jackson St, Saint Paul, MN 55101-2502 | 2014-03-25 |
| 1861835274 | Jordan P Barker | Orthopaedic Surgery | 435 Phalen Blvd, Saint Paul, MN 55130 | 2013-04-16 |
| Find all providers in SAINT PAUL | ||||
| City | SAINT PAUL |
| Zip Code | 55130 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.