Basic Information
Provider Information
NPI: 1518963198
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAZI
FirstName: NADEEM
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1780 E FLORENCE BLVD
Address2: STE 104
City: CASA GRANDE
State: AZ
PostalCode: 851224782
CountryCode: US
TelephoneNumber: 5204261928
FaxNumber: 5204269088
Practice Location
Address1: 1780 E FLORENCE BLVD
Address2: STE 104
City: CASA GRANDE
State: AZ
PostalCode: 851224782
CountryCode: US
TelephoneNumber: 5204261928
FaxNumber: 5204269088
Other Information
ProviderEnumerationDate: 06/28/2005
LastUpdateDate: 10/18/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X25728AZY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

ID Information
IDTypeStateIssuerDescription
1Z021201AZHEALTHNETOTHER
9599901 PACIFICARE PPOOTHER
AZ081062001AZBCBSOTHER
PIM21KAZINA101 MERCYCAREPLAN PREMIUM SHAOTHER
60110101 HUMANAOTHER
39396805AZ MEDICAID
62867001 ANTHEM BLUE CROSSOTHER
9596401 PACIFICARE HMOOTHER
10001179201 RAILROAD MEDICAREOTHER
761283901 DIVISION OF MEDICAL ASSTOTHER
100282801 AETNAOTHER


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