Healthcare Provider Details

I. General information

NPI: 1871728675
Provider Name (Legal Business Name): IMRAN H KAZMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 GATEWAY DR
SYCAMORE IL
60178-3192
US

IV. Provider business mailing address

1850 GATEWAY DR
SYCAMORE IL
60178-3192
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-8671
  • Fax: 815-756-4892
Mailing address:
  • Phone: 815-758-8671
  • Fax: 815-756-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036130652
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036130652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: