Basic Information
| Provider Information | |||||||||
| NPI: | 1306018007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAZI SYED | ||||||||
| FirstName: | RASHAD | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4425 N PORT WASHINGTON RD | ||||||||
| Address2: | CSMCP CLINIC CREDENTIALING | ||||||||
| City: | GLENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532121082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143262218 | ||||||||
| FaxNumber: | 4143262208 | ||||||||
| Practice Location | |||||||||
| Address1: | 2350 N LAKE DRIVE, SUITE 206 | ||||||||
| Address2: | CSMCP CARDIAC RHYTHM SPECIALISTS | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532112984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142987280 | ||||||||
| FaxNumber: | 2483585125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 08/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 62574 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | RK083913 | 01 | MI | LICENSE | OTHER | 1346398971 | 01 | MI | GRP NPI | OTHER | 5359802 | 05 | MI | MEDICAID | 110F336360 | 01 | MI | BCBSM | OTHER |