Provider Demographics
NPI:1750311551
Name:KAZA, SRINIVAS (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:KAZA
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 1:2326 S CONGRESS AVE STE 2D
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7614
Mailing Address - Country:US
Mailing Address - Phone:561-801-1223
Mailing Address - Fax:561-828-3974
Practice Address - Street 1:142 JOHN F KENNEDY DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1159
Practice Address - Country:US
Practice Address - Phone:561-439-1500
Practice Address - Fax:561-439-9902
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97552208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000612400Medicaid
FL000612400Medicaid
7775839OtherAETNA
9997152OtherCIGNA
FL12170OtherDIMENSION HEALTH PPO
FLP10000135876OtherSUNSHINE STATE HEALTH
FLP00706802OtherRAILROAD MEDICARE
000000490411OtherANTHEM BCBS
KY64125602Medicaid
FLP307750OtherFREEDOM
KYP00448578OtherRAILROAD MEDICARE
FL04285OtherBCBS
FL323626OtherAVMED
FL556215OtherWELLCARE
FLP930115OtherOPTIMUM
7775839OtherAETNA
9997152OtherCIGNA
FL556215OtherWELLCARE
KY00107002Medicare PIN