Provider Demographics
NPI:1992196307
Name:AUSTIN ORTHOPEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:AUSTIN ORTHOPEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:K. STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-219-0038
Mailing Address - Street 1:23290 OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8038
Mailing Address - Country:US
Mailing Address - Phone:507-219-0038
Mailing Address - Fax:952-461-1012
Practice Address - Street 1:14051 BURNHAVEN DR STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4400
Practice Address - Country:US
Practice Address - Phone:507-219-0038
Practice Address - Fax:952-461-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-08
Last Update Date:2015-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34220261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty