Healthcare Provider Details

I. General information

NPI: 1952663338
Provider Name (Legal Business Name): NAZIA KULSUM-MECCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARBARA JORDAN BLVD, STE 200
AUSTIN TX
78723
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD, STE 200
AUSTIN TX
78723
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-1860
  • Fax: 512-628-1861
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-9759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036138995
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number036-138995
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberT9730
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: