Provider Demographics
NPI:1750321428
Name:KAZI, AZIMUDDIN (MD)
Entity Type:Individual
Prefix:
First Name:AZIMUDDIN
Middle Name:
Last Name:KAZI
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 1:30 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2378
Mailing Address - Country:US
Mailing Address - Phone:203-888-7846
Mailing Address - Fax:
Practice Address - Street 1:2590 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5838
Practice Address - Country:US
Practice Address - Phone:203-377-5988
Practice Address - Fax:203-380-0531
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0419412084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO001419416Medicaid
CO061076183OtherTAX ID NUMBER
CO001419416Medicaid
CT130000609Medicare ID - Type UnspecifiedMEDICARE ID NUMBER