Provider Demographics
NPI:1336422914
Name:SEWHSHS MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:SEWHSHS MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:KAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-234-2120
Mailing Address - Street 1:211 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1915
Mailing Address - Country:US
Mailing Address - Phone:618-234-2120
Mailing Address - Fax:618-222-4768
Practice Address - Street 1:211 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1915
Practice Address - Country:US
Practice Address - Phone:618-234-2120
Practice Address - Fax:618-222-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03606045Medicaid
ILD14502Medicare UPIN
IL03606045Medicaid