Healthcare Provider Details

I. General information

NPI: 1750321428
Provider Name (Legal Business Name): AZIMUDDIN KAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 MAIN ST
STRATFORD CT
06615-5838
US

IV. Provider business mailing address

30 BROOKFIELD RD
SEYMOUR CT
06483-2378
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-5988
  • Fax: 203-380-0531
Mailing address:
  • Phone: 203-888-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number041941
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: