Healthcare Provider Details

I. General information

NPI: 1245317072
Provider Name (Legal Business Name): ESAM A. KAZEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HEALTH SYSTEM 44405 WOODWARD H-24
PONTIAC MI
48053
US

IV. Provider business mailing address

HENRY FORD HEALTH SYSTEM 44405 WOODWARD H-24
PONTIAC MI
48053
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-3526
  • Fax: 248-858-3532
Mailing address:
  • Phone: 248-858-3526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301066879
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: