Provider Demographics
NPI:1194847244
Name:BIRIA, MAZDA (MD)
Entity Type:Individual
Prefix:
First Name:MAZDA
Middle Name:
Last Name:BIRIA
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 1:9119 W 74TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2268
Mailing Address - Country:US
Mailing Address - Phone:913-632-9400
Mailing Address - Fax:913-632-9444
Practice Address - Street 1:9119 W 74TH ST STE 350
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2268
Practice Address - Country:US
Practice Address - Phone:913-632-9400
Practice Address - Fax:913-632-9444
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012024120207R00000X, 207RC0000X, 207RC0001X
KS946196207R00000X
KS0432319207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1194847244Medicaid
MO1194847244Medicaid
MO701000164Medicare UPIN