Provider Demographics
NPI:1558464883
Name:OZA, SUDHIR R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:R
Last Name:OZA
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 1:16111 LORRAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:216-252-8444
Mailing Address - Fax:
Practice Address - Street 1:16111 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5520
Practice Address - Country:US
Practice Address - Phone:216-252-8444
Practice Address - Fax:216-252-7224
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045653207RG0300X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9916374OtherMEDICARE GROUP PIN
OH000000130888OtherBLUE CROSS AND BLUE SHIELD PIN
OH0444031Medicaid
OHCK3114OtherRAILROAD GROUP PIN
OH110146232OtherRAILROAD PIN
OH1851587455OtherGROUP NPI
OH0444031Medicaid