Basic Information
| Provider Information | |||||||||
| NPI: | 1669671251 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SKAZ HOLDING, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AM DIABETES & ENDOCRINOLOGY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2996 KATE BOND RD | ||||||||
| Address2: | SUITE 413 | ||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381334030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013840065 | ||||||||
| FaxNumber: | 9012661165 | ||||||||
| Practice Location | |||||||||
| Address1: | 2996 KATE BOND RD | ||||||||
| Address2: | SUITE 413 | ||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381334030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013840065 | ||||||||
| FaxNumber: | 9012661165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | LATIF | ||||||||
| AuthorizedOfficialFirstName: | KASHIF | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9013840065 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.