Provider Demographics
NPI:1619197225
Name:M. MICHAEL KAZEMI, M.D.
Entity Type:Organization
Organization Name:M. MICHAEL KAZEMI, M.D.
Other - Org Name:MUSTAFA MICHAEL KAZEMI, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:M. MICHAEL
Authorized Official - Middle Name:
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:#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:#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:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61310207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G613101Medicaid
CA00G613100Medicare ID - Type UnspecifiedMEDICARE
CA00G613101Medicaid