Healthcare Provider Details

I. General information

NPI: 1457338493
Provider Name (Legal Business Name): MOHAMED N KUZIEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11123 S TOWNE SQ STE. #E
SAINT LOUIS MO
63123-7816
US

IV. Provider business mailing address

15065 CLAYTON RD
CHESTERFIELD MO
63017-7045
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-4537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR8332
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: