Provider Demographics
NPI:1366508228
Name:QAZI, ABDUL SAMI (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:SAMI
Last Name:QAZI
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 1:5218 BECK DR STE 12
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9132
Mailing Address - Country:US
Mailing Address - Phone:574-335-7700
Mailing Address - Fax:
Practice Address - Street 1:1915 LAKE AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-9366
Practice Address - Country:US
Practice Address - Phone:574-948-4000
Practice Address - Fax:574-948-5454
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01079521A207Q00000X, 208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001142877OtherBCBS
IN300009791Medicaid