Healthcare Provider Details

I. General information

NPI: 1265128193
Provider Name (Legal Business Name): AMENA KAZMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVENUE SOUTH MINNEAPOLIS
MINNEAPOLIS MN
55415
US

IV. Provider business mailing address

701 PARK AVENUE SOUTH MINNEAPOLIS
MINNEAPOLIS MN
55415
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-3000
  • Fax:
Mailing address:
  • Phone: 612-873-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.178659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: