MEDICARE: NINA L KAZEROONI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	ME82160	FL
2	2085N0700X	Neuroradiology Physician	ME82160	FL
3	2085N0904X	Nuclear Radiology Physician	ME82160	FL
4	2085P0229X	Pediatric Radiology Physician	ME82160	FL
5	2085R0202X	Diagnostic Radiology Physician	ME82160	FL
6	2085R0204X	Vascular & Interventional Radiology Physician	ME82160	FL
7	2085U0001X	Diagnostic Ultrasound Physician	ME82160	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	08689	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003835208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA L KAZEROONI MD

Provider Business Mailing Address
First Line	:	7908 MONTEREY BAY DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2934
Country	:	US
Telephone Number	:	904-507-9318
Fax Number	:

Provider Business Practice Location Address
First Line	:	7908 MONTEREY BAY DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2934
Country	:	US
Telephone Number	:	904-507-9318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	02/12/2015

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Directions to “ NINA L KAZEROONI MD” Practice Location

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