MEDICARE: CRAIG ALAN KAZMAIER ARNP

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	363L00000X	Nurse Practitioner	44810	KS
2	364SE0003X	Emergency Clinical Nurse Specialist	44810	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	664893	OTHER		FIRSTGUARD
2	10001787600	OTHER		CHP PROVIDER NUMBER

General Provider Information

NPI Number	:	1700998093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG ALAN KAZMAIER ARNP

Provider Business Mailing Address
First Line	:	2330 SHAWNEE MISSION PKWY
Second Line	:	MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE 312
City	:	WESTWOOD
State	:	KS
Zip	:	66205-2005
Country	:	US
Telephone Number	:	913-588-9000
Fax Number	:	913-588-9822

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	PROFESSIONAL SERVICES OF KU HOSPITAL
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-0001
Country	:	US
Telephone Number	:	913-588-6504
Fax Number	:	913-588-9104

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/14/2007

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