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General NPI Number Information
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NPI Number | 1568220903
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Entity Type | Individual
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Provider Name | SOBHI GHEATH KAZMOUZ
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Gender | Male
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1 HOSPITAL DR
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City | COLUMBIA
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State | MO
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Zip | 65212-2603
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Country | US
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Telephone | 309-569-6173
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Fax |
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Provider Business Mailing Address
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Address Line | 2157 W 18TH PL APT 2R
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City | CHICAGO
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State | IL
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Zip | 60608-2603
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 2025023829
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License Number State | MO
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