Healthcare Provider Details

I. General information

NPI: 1336422914
Provider Name (Legal Business Name): SEWHSHS MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 3RD ST
BELLEVILLE IL
62220-1915
US

IV. Provider business mailing address

211 S 3RD ST
BELLEVILLE IL
62220-1915
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-2120
  • Fax: 618-222-4768
Mailing address:
  • Phone: 618-234-2120
  • Fax: 618-222-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABDUL W KAZI
Title or Position: PHYSICIAN
Credential: MD
Phone: 618-234-2120