1306018007 NPI number — DR. RASHAD H KHAZI SYED MD

Table of content: DR. RASHAD H KHAZI SYED MD (NPI 1306018007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306018007 NPI number — DR. RASHAD H KHAZI SYED MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAZI SYED
Provider First Name:
RASHAD
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306018007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4425 N PORT WASHINGTON RD
Provider Second Line Business Mailing Address:
CSMCP CLINIC CREDENTIALING
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53212-1082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-326-2218
Provider Business Mailing Address Fax Number:
414-326-2208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 N LAKE DRIVE, SUITE 206
Provider Second Line Business Practice Location Address:
CSMCP CARDIAC RHYTHM SPECIALISTS
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53211-2984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-298-7280
Provider Business Practice Location Address Fax Number:
248-358-5125
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X , with the licence number:  62574 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RK083913 . This is a "LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1346398971 . This is a "GRP NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5359802 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110F336360 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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