Provider Demographics
NPI:1851392625
Name:KAZA, VIJAYA KIRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA KIRAN
Middle Name:
Last Name:KAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIJAYAKIRAN
Other - Middle Name:
Other - Last Name:SURAPANENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24789 TODDY LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2075
Mailing Address - Country:US
Mailing Address - Phone:248-910-3884
Mailing Address - Fax:
Practice Address - Street 1:24789 TODDY LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2075
Practice Address - Country:US
Practice Address - Phone:248-910-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061896208000000X
TXR1792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI409188110Medicaid
MI409188110Medicaid