Healthcare Provider Details

I. General information

NPI: 1518963198
Provider Name (Legal Business Name): NADEEM A KAZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 E FLORENCE BLVD STE 104
CASA GRANDE AZ
85122-4782
US

IV. Provider business mailing address

1780 E FLORENCE BLVD STE 104
CASA GRANDE AZ
85122-4782
US

V. Phone/Fax

Practice location:
  • Phone: 520-426-1928
  • Fax: 520-426-9088
Mailing address:
  • Phone: 520-426-1928
  • Fax: 520-426-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25728
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: