Provider Demographics
NPI:1427022672
Name:KAZI, FAHIM A (MD)
Entity Type:Individual
Prefix:
First Name:FAHIM
Middle Name:A
Last Name:KAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:354 BIRNIE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1109
Mailing Address - Country:US
Mailing Address - Phone:413-733-3470
Mailing Address - Fax:413-732-4216
Practice Address - Street 1:98 SHAKER RD
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:413-525-1554
Practice Address - Fax:413-525-7764
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222714207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2100762Medicaid
MAA38488Medicare PIN
I04152Medicare UPIN
MA2100762Medicaid