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
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 25728 | AZ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
ID | Type | State | Issuer | Description | 1Z0212 | 01 | AZ | HEALTHNET | OTHER | 95999 | 01 |   | PACIFICARE PPO | OTHER | AZ0810620 | 01 | AZ | BCBS | OTHER | PIM21KAZINA1 | 01 |   | MERCYCAREPLAN PREMIUM SHA | OTHER | 601101 | 01 |   | HUMANA | OTHER | 393968 | 05 | AZ |   | MEDICAID | 628670 | 01 |   | ANTHEM BLUE CROSS | OTHER | 95964 | 01 |   | PACIFICARE HMO | OTHER | 100011792 | 01 |   | RAILROAD MEDICARE | OTHER | 7612839 | 01 |   | DIVISION OF MEDICAL ASST | OTHER | 1002828 | 01 |   | AETNA | OTHER |