Healthcare Provider Details

I. General information

NPI: 1528051620
Provider Name (Legal Business Name): GREATER ARIZONA GASTROENTEROLOGY & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1780 E FLORENCE BLVD #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: DR. NADEEM A KAZI
Title or Position: PRESIDENT
Credential: MD
Phone: 520-426-1928