Provider Demographics
NPI:1912984766
Name:OZA, YAGNESH V (MD)
Entity Type:Individual
Prefix:DR
First Name:YAGNESH
Middle Name:V
Last Name:OZA
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 1:14995 N..42ND ST
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864
Mailing Address - Country:US
Mailing Address - Phone:618-242-6484
Mailing Address - Fax:
Practice Address - Street 1:4117 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6262
Practice Address - Country:US
Practice Address - Phone:618-244-6500
Practice Address - Fax:618-244-6422
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4100068OtherBLUE CROSS BLUE SHIELD
IL4100068OtherBLUE CROSS BLUE SHIELD
IL685540Medicare ID - Type UnspecifiedPROVIDER NUMBER