=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336422914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEWHSHS MEDICAL GROUP INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2011
-----------------------------------------------------
Last Update Date | 03/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 S 3RD ST
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62220-1915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-234-2120
-----------------------------------------------------
Fax | 618-222-4768
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 S 3RD ST
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62220-1915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-234-2120
-----------------------------------------------------
Fax | 618-222-4768
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. ABDUL W KAZI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 618-234-2120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------