Provider Demographics
NPI:1659347409
Name:KAGZI, MOHAMMAD WASEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:WASEEM
Last Name:KAGZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:731 S IL ROUTE 21
Mailing Address - Street 2:UNIT 120
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3803
Mailing Address - Country:US
Mailing Address - Phone:847-855-9700
Mailing Address - Fax:847-855-8990
Practice Address - Street 1:731 S IL ROUTE 21
Practice Address - Street 2:UNIT 120
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3803
Practice Address - Country:US
Practice Address - Phone:847-855-9700
Practice Address - Fax:847-855-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036091991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G37407Medicare UPIN
209279Medicare ID - Type Unspecified