Provider Demographics
NPI:1982978748
Name:KAZENSKE, FAUSTINO MIRES (DO)
Entity type:Individual
Prefix:DR
First Name:FAUSTINO
Middle Name:MIRES
Last Name:KAZENSKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5627
Mailing Address - Country:US
Mailing Address - Phone:405-947-0911
Mailing Address - Fax:405-942-5043
Practice Address - Street 1:3301 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5627
Practice Address - Country:US
Practice Address - Phone:405-947-0911
Practice Address - Fax:405-942-5043
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-26
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90018947-0054207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery