Provider Demographics
NPI:1134122914
Name:KAZI, AMER M (MD)
Entity type:Individual
Prefix:DR
First Name:AMER
Middle Name:M
Last Name:KAZI
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 1:6915 N FIR RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4754
Mailing Address - Country:US
Mailing Address - Phone:574-234-2191
Mailing Address - Fax:574-234-7720
Practice Address - Street 1:6915 N FIR RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4754
Practice Address - Country:US
Practice Address - Phone:574-234-2191
Practice Address - Fax:574-231-7720
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059304A2084N0400X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000576523OtherANTHEM
IN200375770Medicaid
IN000000576523OtherANTHEM
IN200375770Medicaid