Provider Demographics
NPI:1154640902
Name:KAZMI, SYED S (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:S
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 1:1611 FIR AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9462
Mailing Address - Country:US
Mailing Address - Phone:312-217-2581
Mailing Address - Fax:
Practice Address - Street 1:616 W 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5307
Practice Address - Country:US
Practice Address - Phone:312-421-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2023-07-27
Deactivation Date:2009-04-28
Deactivation Code:
Reactivation Date:2010-05-19
Provider Licenses
StateLicense IDTaxonomies
IN01077884A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine