Provider Demographics
NPI:1710977186
Name:KAZA, PURNIMA (MD)
Entity Type:Individual
Prefix:
First Name:PURNIMA
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 1:801 A HWY 78 SUITE 201
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4000
Mailing Address - Country:US
Mailing Address - Phone:972-429-1077
Mailing Address - Fax:972-429-1173
Practice Address - Street 1:801 A HWY 78 SUITE 201
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4000
Practice Address - Country:US
Practice Address - Phone:972-429-1077
Practice Address - Fax:972-429-1173
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2159Medicare ID - Type Unspecified
TX00W063Medicare ID - Type Unspecified
TXI10683Medicare UPIN