Provider Demographics
NPI:1306010145
Name:YAZDI N. AMARIA,M.D.,P.C.
Entity Type:Organization
Organization Name:YAZDI N. AMARIA,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAZDI
Authorized Official - Middle Name:N
Authorized Official - Last Name:AMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-651-3218
Mailing Address - Street 1:111 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1728
Mailing Address - Country:US
Mailing Address - Phone:269-651-3218
Mailing Address - Fax:269-651-3219
Practice Address - Street 1:111 S MONROE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1728
Practice Address - Country:US
Practice Address - Phone:269-651-3218
Practice Address - Fax:269-651-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1018312OtherMCLAREN HEALTH PLAN
0005218428OtherAETNA
MI102883801Medicaid
MI13039OtherHEALTH PLAN OF MICHIGAN
MI0107500492OtherBLUE CROSS BLUE SHIELD
MI113029OtherGREAT LAKES HEALTH PLAN
0005218428OtherAETNA
MIE98129Medicare UPIN
MI113029OtherGREAT LAKES HEALTH PLAN
MI0P55930Medicare PIN