Provider Demographics
NPI:1629323746
Name:RZASA, CALLIE LEEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:LEEANNE
Last Name:RZASA
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 1:138 LEADER AVE
Mailing Address - Street 2:RM 252
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40506-3215
Mailing Address - Country:US
Mailing Address - Phone:859-323-5962
Mailing Address - Fax:
Practice Address - Street 1:138 LEADER AVE
Practice Address - Street 2:RM 252
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506-3215
Practice Address - Country:US
Practice Address - Phone:859-323-5962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP2342080P0202X
CAA1184292080P0202X, 390200000X
KY496192080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program