Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | R6590 | TX |
NPI | 1043256399 |
---|---|
Provider Name | Syed Q Kazmi |
First Address | Portland, ME 04102-2363 |
Second Address | Round Rock, TX 78681-8025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 30/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030294 | ANTHEM (01) | ME |
1042306 | AETNA (01) | ME |
339350099 | (05) | ME |
G31938 | (02) | ME |
M109871 | CIGNA (01) | ME |