Healthcare Provider Details

I. General information

NPI: 1801957063
Provider Name (Legal Business Name): ALEXANDER KAZOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S 3RD ST
BELLEVILLE IL
62220-1952
US

IV. Provider business mailing address

4251 FLAD AVE
SAINT LOUIS MO
63110-3506
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-5480
  • Fax:
Mailing address:
  • Phone: 917-669-5086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39020000X
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number257069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: