Provider Demographics
NPI:1437240892
Name:KAZA, LEELAMANI NAGAPUSHPA (MD)
Entity Type:Individual
Prefix:
First Name:LEELAMANI
Middle Name:NAGAPUSHPA
Last Name:KAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAGAPUSHPA
Other - Middle Name:LEELAMANI
Other - Last Name:KAZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:P O BOX 70
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-9000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 E. BRIN
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160
Practice Address - Country:US
Practice Address - Phone:972-524-6452
Practice Address - Fax:972-551-8513
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK66222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB101697Medicare PIN
8J0706Medicare PIN