Healthcare Provider Details

I. General information

NPI: 1033057377
Provider Name (Legal Business Name): SYED KAZMI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALI KAZMI

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7165 CLEARVISTA WAY
INDIANAPOLIS IN
46256-4621
US

IV. Provider business mailing address

7165 CLEARVISTA WAY PSYCH PAVILLION
INDIANAPOLIS IN
46256-4621
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-5700
  • Fax: 317-621-7896
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11024994A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: