Provider Demographics
NPI:1043256399
Name:KAZMI, SYED Q (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:Q
Last Name:KAZMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2363
Mailing Address - Country:US
Mailing Address - Phone:207-829-6009
Mailing Address - Fax:207-829-6022
Practice Address - Street 1:1400 HESTERS CROSSING RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-8025
Practice Address - Country:US
Practice Address - Phone:207-829-6009
Practice Address - Fax:207-829-6022
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6590208100000X
MA150091208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME030294OtherANTHEM
ME339350099Medicaid
ME1042306OtherAETNA
MEM109871OtherCIGNA
MEG31938Medicare UPIN
ME339350099Medicaid