Healthcare Provider Details

I. General information

NPI: 1972578250
Provider Name (Legal Business Name): DEMETRIOS JAMES KAZAKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 OLD DONATION PKWY
VIRGINIA BEACH VA
23454-3064
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-5300
  • Fax: 757-395-5322
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101051280
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: