Healthcare Provider Details

I. General information

NPI: 1447581624
Provider Name (Legal Business Name): M MICHAEL KAZEMI MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 NORRIS CANYON RD SUITE 308
SAN RAMON CA
94583-5409
US

IV. Provider business mailing address

5401 NORRIS CANYON RD SUITE 308
SAN RAMON CA
94583-5409
US

V. Phone/Fax

Practice location:
  • Phone: 925-866-8822
  • Fax: 925-866-8323
Mailing address:
  • Phone: 925-866-8822
  • Fax: 925-866-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. M MICHAEL KAZEMI
Title or Position: OWNER
Credential: MD
Phone: 925-866-8822