Provider Demographics
NPI:1235929084
Name:KAZMI, SHUMILA
Entity type:Individual
Prefix:
First Name:SHUMILA
Middle Name:
Last Name:KAZMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 COLTON RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5633
Mailing Address - Country:US
Mailing Address - Phone:815-995-1675
Mailing Address - Fax:
Practice Address - Street 1:3746 NATIONAL RD E
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3643
Practice Address - Country:US
Practice Address - Phone:765-966-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN12014752A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program