Provider Demographics
NPI:1881927903
Name:GHAZI, REZA (MD)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:GHAZI
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 1:1868 KIRTS BLVD
Mailing Address - Street 2:APT NO#208
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4337
Mailing Address - Country:US
Mailing Address - Phone:310-334-9520
Mailing Address - Fax:
Practice Address - Street 1:1868 KIRTS BLVD
Practice Address - Street 2:APT NO#208
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4337
Practice Address - Country:US
Practice Address - Phone:310-334-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094771208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery