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General NPI Number Information
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NPI Number | 1144523630
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Entity Type | Individual
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Provider Name | JORDAN ATANASOV KAZAKOV MD
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Gender | Male
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE # BOLWELL 6
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-1722
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 PROSPECT AVE E APT 805
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City | CLEVELAND
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State | OH
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Zip | 44115-2349
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Country | US
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Telephone | 843-902-7253
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 330879
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | FK4226595
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 330879
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | FK4226595
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 330879
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License Number State | LA
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