MEDICARE: MICHAEL NAZARIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	229663	MA
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	P7962	TX
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	261140	NY

General Provider Information

NPI Number	:	1245401637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL NAZARIAN M.D.

Provider Business Mailing Address
First Line	:	757 8TH AVE
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2522
Country	:	US
Telephone Number	:	817-336-4454
Fax Number	:	817-336-4440

Provider Business Practice Location Address
First Line	:	757 8TH AVE
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2522
Country	:	US
Telephone Number	:	817-336-4454
Fax Number	:	817-336-4440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	10/11/2013

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