MEDICARE: DR. NATALIA KAZAKEVICH M.D

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	2084P0800X	Psychiatry Physician	P0742	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P0742	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1447570999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIA KAZAKEVICH M.D

Provider Business Mailing Address
First Line	:	9074 ROCKY RIDGE DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77302-5615
Country	:	US
Telephone Number	:	281-466-1891
Fax Number	:	281-296-9044

Provider Business Practice Location Address
First Line	:	5314 DASHWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4603
Country	:	US
Telephone Number	:	713-600-9500
Fax Number	:	281-296-9044

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

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	02/21/2016

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