Provider Demographics
NPI:1336196054
Name:KAZKAZ, BASSEL (MD)
Entity Type:Individual
Prefix:
First Name:BASSEL
Middle Name:
Last Name:KAZKAZ
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 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0018
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1890 SILVER CROSS BLVD STE 345
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:630-933-4056
Practice Address - Fax:630-933-4057
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38376-0202084N0400X
IL0360964132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01349679OtherMEDICARE RAILROAD (INDIVIDUAL)
ILCA4748OtherMEDICARE RAILROAD (GROUP)
WI7610OtherDEAN HEALTH INSURANCE
WI7610OtherDEAN HEALTH INSURANCE
WI130022220Medicare PIN
ILP01349679OtherMEDICARE RAILROAD (INDIVIDUAL)
H16661Medicare UPIN
WI062174150Medicare PIN