Provider Demographics
NPI:1396883534
Name:DAZA, RAMIRO NMN (MD)
Entity type:Individual
Prefix:DR
First Name:RAMIRO
Middle Name:NMN
Last Name:DAZA
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 1:1288 SILVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3092
Mailing Address - Country:US
Mailing Address - Phone:517-349-3202
Mailing Address - Fax:
Practice Address - Street 1:1115 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1669
Practice Address - Country:US
Practice Address - Phone:517-346-4700
Practice Address - Fax:517-346-4855
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404434207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0803318202OtherBLUE CROSS
MI6600003OtherPHYSICIAN HEALTH PLANN
MI03318201082Medicaid
MI1504Medicare PIN
MI0803318202OtherBLUE CROSS
MI6600003OtherPHYSICIAN HEALTH PLANN
MI03318201082Medicaid
MIMI1503Medicare PIN