Provider Demographics
NPI:1396840914
Name:SAZAMA, KATHLEEN (MD JD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SAZAMA
Suffix:
Gender:F
Credentials:MD JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2342
Mailing Address - Country:US
Mailing Address - Phone:352-224-1640
Mailing Address - Fax:352-224-1650
Practice Address - Street 1:4039 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2342
Practice Address - Country:US
Practice Address - Phone:352-224-1640
Practice Address - Fax:352-224-1650
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103651207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8772K2Medicare ID - Type Unspecified
E71343Medicare UPIN