MEDICARE: REZA KAZEMI M.D.

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	207Q00000X	Family Medicine Physician	R-10449	IA

General Provider Information

NPI Number	:	1710361605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REZA KAZEMI M.D.

Provider Business Mailing Address
First Line	:	2202 N STOCKTON HILL RD
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4622
Country	:	US
Telephone Number	:	928-263-4828
Fax Number	:	928-681-8816

Provider Business Practice Location Address
First Line	:	2202 N STOCKTON HILL RD
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4622
Country	:	US
Telephone Number	:	928-263-4828
Fax Number	:	928-681-8816

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

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	06/19/2021

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Directions to “ REZA KAZEMI M.D.” Practice Location

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