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General NPI Number Information
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NPI Number | 1992196307
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Entity Type | Organization
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Legal Business Name | AUSTIN ORTHOPEDICS & SPORTS MEDICINE
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Dates
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Enumeration Date | 02/08/2015
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Last Update Date | 02/08/2015
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Provider Practice Location Address
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Address Line | 14051 BURNHAVEN DR STE 100
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City | BURNSVILLE
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State | MN
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Zip | 55337-4400
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Country | US
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Telephone | 507-219-0038
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Fax | 952-461-1012
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Provider Business Mailing Address
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Address Line | 23290 OTTAWA AVE
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City | LAKEVILLE
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State | MN
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Zip | 55044-8038
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Country | US
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Telephone | 507-219-0038
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Fax | 952-461-1012
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. K. STEPHEN KAZI
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Credential | M.D.
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Telephone | 507-219-0038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 34220
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License Number State | MN
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