Healthcare Provider Details

I. General information

NPI: 1326036930
Provider Name (Legal Business Name): KAUKAB NASEER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 MORRISON SPRINGS RD SUITE 300
CHATTANOOGA TN
37415-3416
US

IV. Provider business mailing address

6918 SHALLOWFORD RD SUITE 206
CHATTANOOGA TN
37421-6784
US

V. Phone/Fax

Practice location:
  • Phone: 423-877-4524
  • Fax: 423-875-5860
Mailing address:
  • Phone: 423-855-2552
  • Fax: 423-855-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number028243
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: