MEDICARE: MS. PHYLLIS MARIE KAZIMER P.A.-C.

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	363AM0700X	Medical Physician Assistant	50000764	OH

General Provider Information

NPI Number	:	1164611018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHYLLIS MARIE KAZIMER P.A.-C.

Provider Business Mailing Address
First Line	:	182 EAST AVE
Second Line	:
City	:	TALLMADGE
State	:	OH
Zip	:	44278-2311
Country	:	US
Telephone Number	:	330-630-9726
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 EAST AVE
Second Line	:
City	:	TALLMADGE
State	:	OH
Zip	:	44278-2311
Country	:	US
Telephone Number	:	330-630-9726
Fax Number	:

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

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/17/2007

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