Basic Information
| Provider Information | |||||||||
| NPI: | 1528051620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER ARIZONA GASTROENTEROLOGY & ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1780 E FLORENCE BLVD | ||||||||
| Address2: | #104 | ||||||||
| City: | CASA GRANDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851224782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204261928 | ||||||||
| FaxNumber: | 5204269088 | ||||||||
| Practice Location | |||||||||
| Address1: | 1780 E FLORENCE BLVD | ||||||||
| Address2: | #104 | ||||||||
| City: | CASA GRANDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851224782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204261928 | ||||||||
| FaxNumber: | 5204269088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | KAZI | ||||||||
| AuthorizedOfficialFirstName: | NADEEM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5204261928 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 25728 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | AZ0810620 | 01 | AZ | BCBS | OTHER | 628670 | 01 | ANTHEM BLUE CROSS | OTHER | PIM21KAZINA1 | 01 | MERCYCAREPLAN PREMIUM | OTHER | 1Z0212 | 01 | AZ | HEALTHNET | OTHER | 393968 | 05 | AZ | MEDICAID | 95964 | 01 | PACIFICARE HMO | OTHER | 601101 | 01 | HUMANA | OTHER | 95999 | 01 | PACIFICARE PPO | OTHER | 1002828 | 01 | AETNA | OTHER | 7612839 | 01 | DIVISION OF MEDICAL ASST | OTHER |