MEDICARE: IMTIAZ KAZI FAMILY PRACTICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35-06-6089-K	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033249032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMTIAZ KAZI FAMILY PRACTICE, INC.

Provider Business Mailing Address
First Line	:	200 BRADENTON AVE
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-7515
Country	:	US
Telephone Number	:	614-793-1980
Fax Number	:	614-793-1985

Provider Business Practice Location Address
First Line	:	1460 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1047
Country	:	US
Telephone Number	:	614-445-7755
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IMTIAZ KAZI
Credential	:	M.D.
Telephone Number	:	614-445-7755

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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