Basic Information
| Provider Information | |||||||||
| NPI: | 1912398579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAZMI | ||||||||
| FirstName: | MARIUM | ||||||||
| MiddleName: | FATIMA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4980 W 10TH AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330123437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055578444 | ||||||||
| FaxNumber: | 3055575058 | ||||||||
| Practice Location | |||||||||
| Address1: | 4980 W 10TH AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330123437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055578444 | ||||||||
| FaxNumber: | 3055575058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2015 | ||||||||
| LastUpdateDate: | 07/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS13151 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.