Provider Demographics
NPI:1598786436
Name:KAZA, HARSHA (MD)
Entity Type:Individual
Prefix:
First Name:HARSHA
Middle Name:
Last Name:KAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3115 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-3099
Practice Address - Country:US
Practice Address - Phone:847-746-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110833207R00000X
WI46268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13561OtherDEAN HEALTH PLAN
1043509OtherPHYSICIANS PLUS
390808509OtherCIGNA
90002361OtherWEA INS
390808509OtherWPS
390808509OtherCT GENERAL
WI34466000Medicaid
P00151657OtherMEDICARE RAILROAD
34466000OtherHIRSP
390808509CWOtherUNITY
WI34466000Medicaid
I01419Medicare UPIN