Provider Demographics
NPI:1003849621
Name:MANZOOR A KAZI MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:MANZOOR A KAZI MEDICAL ASSOCIATES INC
Other - Org Name:PALM DESERT URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MANZOOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-340-5800
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92261-1118
Mailing Address - Country:US
Mailing Address - Phone:760-340-5800
Mailing Address - Fax:760-340-5700
Practice Address - Street 1:73345 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3909
Practice Address - Country:US
Practice Address - Phone:760-340-5800
Practice Address - Fax:760-340-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A641060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641060Medicaid
CAZZZ18991ZMedicare ID - Type UnspecifiedMEDICARE
CA00A641060Medicaid