Provider Demographics
NPI:1619976271
Name:AMARIA, YAZDI N (MD)
Entity Type:Individual
Prefix:DR
First Name:YAZDI
Middle Name:N
Last Name:AMARIA
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 1:111 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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13039OtherHEALTH PLAN OF MICHIGAN
0005218428OtherAETNA
MI0107500492OtherBLUE CROSS BLUE SHIELD
MI1018312OtherMCLAREN HEALTH PLAN
MI113029OtherGREAT LAKES HEALTH PLAN
MI2883801Medicaid
MI2883801Medicaid
080185820Medicare PIN
MI113029OtherGREAT LAKES HEALTH PLAN
MI1018312OtherMCLAREN HEALTH PLAN