Individual
DR. IMRAN KAZEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01063605A
IN
2085R0202X
Diagnostic Radiology Physician
36483
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001144399
ANTHEM PROVIDER NUMBER
IN
05
—
192198
—
AZ
01
—
1Z7086
HEALTH NET OF ARIZONA
AZ
05
—
300010466
—
IN
01
—
AZ0221810
BCBSAZ
AZ
Enumeration date
10/23/2006
Last updated
02/18/2021
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