MEDICARE: NAZISH R NAQVI IDMT

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1306137328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAZISH R NAQVI IDMT

Provider Business Mailing Address
First Line	:	4101 NW EXPRESSWAY APT 16096
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1603
Country	:	US
Telephone Number	:	405-326-6929
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 NW EXPRESSWAY APT 16096
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1603
Country	:	US
Telephone Number	:	405-326-6929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	04/25/2011

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