Provider Demographics
NPI:1568420040
Name:SAZGARI, REZA S (MD)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:S
Last Name:SAZGARI
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 1:23625 COMMERCE PARK
Mailing Address - Street 2:STE 204
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-255-5700
Mailing Address - Fax:216-255-5701
Practice Address - Street 1:32227 ARLINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-4217
Practice Address - Country:US
Practice Address - Phone:248-953-4703
Practice Address - Fax:216-255-5701
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010747682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4930796Medicaid
MI700F340300OtherBCBS PROF GRP PIN
MI2085R020XOtherTAXONOMY
OH2905762Medicaid
MII08753OtherUPIN
MI700E021910OtherBCBS PROF GRP PIN
LA1620742Medicaid
MI383162435OtherTAX ID COMMERCIAL INSURANCE
MIRS074768OtherSTATE LICENSE
MI700E021830OtherBCBS PROF GRP PIN
MI4769421Medicaid
MI5968608OtherAETNA
MIP00433250OtherGBA PALMETTO RAILROAD MEDICARE
MI4930796Medicaid
MI700E021830OtherBCBS PROF GRP PIN
OH2905762Medicaid
MI0P30420Medicare PIN