Provider Demographics
NPI:1245401637
Name:NAZARIAN, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NAZARIAN
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 1:757 8TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2522
Mailing Address - Country:US
Mailing Address - Phone:817-336-4454
Mailing Address - Fax:817-336-4440
Practice Address - Street 1:757 8TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2522
Practice Address - Country:US
Practice Address - Phone:817-336-4454
Practice Address - Fax:817-336-4440
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229663390200000X
TXP7962208G00000X
NY261140208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program