Provider Demographics
NPI:1760590012
Name:QAZI, NADEEM GUL (MD)
Entity type:Individual
Prefix:
First Name:NADEEM
Middle Name:GUL
Last Name:QAZI
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 1:13266 BYRD DR STE 100-223
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-5319
Mailing Address - Country:US
Mailing Address - Phone:941-702-0010
Mailing Address - Fax:844-469-1050
Practice Address - Street 1:13266 BYRD DR STE 100-223
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-5319
Practice Address - Country:US
Practice Address - Phone:941-702-0010
Practice Address - Fax:844-469-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163016207R00000X
VA0101058418207UN0902X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760590012Medicaid
WV0012019000Medicaid
WV0012019000Medicaid
G94595Medicare UPIN
QA0878412Medicare ID - Type Unspecified