Basic Information
| Provider Information | |||||||||
| NPI: | 1942269188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAZAKEVICIUS | ||||||||
| FirstName: | RIMANTAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21850 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719031850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016271800 | ||||||||
| FaxNumber: | 5016271899 | ||||||||
| Practice Location | |||||||||
| Address1: | 1424 TANNER ST | ||||||||
| Address2: | |||||||||
| City: | ROCKPORT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721042082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013328612 | ||||||||
| FaxNumber: | 5013324141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E1550 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 136709001 | 05 | AR | MEDICAID |