Provider Demographics
NPI:1992731434
Name:TODD KAZDAN, D.O., P.A.
Entity type:Organization
Organization Name:TODD KAZDAN, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KAZDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-581-7660
Mailing Address - Street 1:6099 STIRLING RD
Mailing Address - Street 2:SUITE 219-222
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7234
Mailing Address - Country:US
Mailing Address - Phone:954-581-7660
Mailing Address - Fax:
Practice Address - Street 1:6099 STIRLING RD
Practice Address - Street 2:SUITE 219-222
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7234
Practice Address - Country:US
Practice Address - Phone:954-581-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66801Medicare UPIN
FLE7817Medicare ID - Type Unspecified