Provider Demographics
NPI:1700383585
Name:KAZEMI, ABRAHEM (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHEM
Middle Name:
Last Name:KAZEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 734240
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-4240
Mailing Address - Country:US
Mailing Address - Phone:708-634-4602
Mailing Address - Fax:
Practice Address - Street 1:6101 REDWOOD SQUARE CTR STE 117
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-4266
Practice Address - Country:US
Practice Address - Phone:338-257-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275044207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology