Provider Demographics
NPI:1225032212
Name:KAZI, MANZOOR A (MD)
Entity Type:Individual
Prefix:
First Name:MANZOOR
Middle Name:A
Last Name:KAZI
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: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:STE 101
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A641060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641060Medicaid
CAG42809Medicare UPIN
CAZZZ18991ZMedicare PIN