Provider Demographics
NPI:1902005812
Name:COBBLER STATION INTERNISTS
Entity Type:Organization
Organization Name:COBBLER STATION INTERNISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:Q
Authorized Official - Last Name:KAZMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-949-0140
Mailing Address - Street 1:5130 CHARLESTOWN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9483
Mailing Address - Country:US
Mailing Address - Phone:812-949-0140
Mailing Address - Fax:812-949-0279
Practice Address - Street 1:5130 CHARLESTOWN RD STE 1
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9483
Practice Address - Country:US
Practice Address - Phone:812-949-0140
Practice Address - Fax:812-949-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044505A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
251530Medicare PIN