Provider Demographics
NPI:1447581624
Name:M MICHAEL KAZEMI MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:M MICHAEL KAZEMI MD A MEDICAL CORPORATION
Other - Org Name:M MICHAEL KAZEMI MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KAZEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-866-8822
Mailing Address - Street 1:5401 NORRIS CANYON RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5409
Mailing Address - Country:US
Mailing Address - Phone:925-866-8822
Mailing Address - Fax:925-866-8323
Practice Address - Street 1:5401 NORRIS CANYON RD
Practice Address - Street 2:SUITE 308
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5409
Practice Address - Country:US
Practice Address - Phone:925-866-8822
Practice Address - Fax:925-866-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG613101Medicaid
CAG613101Medicaid
CAE91898Medicare UPIN