Provider Demographics
NPI:1871661348
Name:RAMARAO KAZA MD PC
Entity Type:Organization
Organization Name:RAMARAO KAZA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-831-2700
Mailing Address - Street 1:4160 JOHN R
Mailing Address - Street 2:SUITE 809
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-831-2700
Mailing Address - Fax:313-831-0430
Practice Address - Street 1:4160 JOHN R
Practice Address - Street 2:SUITE 809
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-831-2700
Practice Address - Fax:313-831-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033043208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1092590Medicaid
MI0829132OtherBLUE CROSS
A78381Medicare UPIN
MI0829132OtherBLUE CROSS