Provider Demographics
NPI:1699762054
Name:NASEEM, KASHIF (MD)
Entity type:Individual
Prefix:
First Name:KASHIF
Middle Name:
Last Name:NASEEM
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 1:3642 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6519
Mailing Address - Country:US
Mailing Address - Phone:706-496-2573
Mailing Address - Fax:706-496-2637
Practice Address - Street 1:3642 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6519
Practice Address - Country:US
Practice Address - Phone:706-496-2573
Practice Address - Fax:706-496-2637
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000916207R00000X
GA058089208M00000X
GA058109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129VUMedicaid
129VUOtherBCBS
1699762054OtherBCBS GA
GA870060696AMedicaid
A935ZOtherMEDCOST
G58089OtherSC CAID
511I110170Medicare PIN
G58089OtherSC CAID
H33638Medicare UPIN