Provider Demographics
NPI:1841220241
Name:RAZA, SYED M (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:M
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:81 BALL PARK RD
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-1792
Mailing Address - Country:US
Mailing Address - Phone:065-738-1000
Mailing Address - Fax:606-574-9995
Practice Address - Street 1:37 BALL PARK RD
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-1701
Practice Address - Country:US
Practice Address - Phone:606-573-4520
Practice Address - Fax:606-573-6392
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY364812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64027675Medicaid
KY64027675Medicaid
KYG88932Medicare UPIN