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General NPI Number Information
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NPI Number | 1104591163
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Entity Type | Individual
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Provider Name | MAZEN KADRI MD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 2650 N LAKEVIEW AVE APT LAKEVIEW
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City | CHICAGO
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State | IL
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Zip | 60614-1840
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Country | US
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Telephone | 734-740-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 N LAKEVIEW AVE APT LAKEVIEW
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City | CHICAGO
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State | IL
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Zip | 60614-1840
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Country | US
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Telephone | 734-740-1660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 107579
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License Number State | MO
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