Provider Demographics
NPI:1750170841
Name:TAGHIZADEH, KASSRA JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:KASSRA
Middle Name:JUSTIN
Last Name:TAGHIZADEH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S WASHINGTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2578
Mailing Address - Country:US
Mailing Address - Phone:989-746-7857
Mailing Address - Fax:
Practice Address - Street 1:912 S WASHINGTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2578
Practice Address - Country:US
Practice Address - Phone:989-746-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351054074208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery