MEDICARE: MICHAEL KAZAK 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	A43888	CA

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

General Provider Information

NPI Number	:	1285732636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KAZAK MD

Provider Business Mailing Address
First Line	:	1040 W MAIN ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458
Country	:	US
Telephone Number	:	805-922-8269
Fax Number	:	805-349-9509

Provider Business Practice Location Address
First Line	:	1040 W MAIN ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458
Country	:	US
Telephone Number	:	805-922-8269
Fax Number	:	805-349-9509

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/24/2023

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