Provider Demographics
NPI:1790178390
Name:NATALIA KAZAKEVICH MD PA INC
Entity Type:Organization
Organization Name:NATALIA KAZAKEVICH MD PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZAKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-384-1560
Mailing Address - Street 1:9074 ROCKY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-5615
Mailing Address - Country:US
Mailing Address - Phone:281-466-1891
Mailing Address - Fax:281-296-9044
Practice Address - Street 1:5314 DASHWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4603
Practice Address - Country:US
Practice Address - Phone:713-600-9500
Practice Address - Fax:281-296-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP07422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0742OtherTEXAS LICENSE
TXP0742OtherTEXAS LICENSE