Healthcare Provider Details

I. General information

NPI: 1639216641
Provider Name (Legal Business Name): KAZA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD RUDNICK LN
DOVER DE
19901-4912
US

IV. Provider business mailing address

18 OLD RUDNICK LN
DOVER DE
19901-4912
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2616
  • Fax: 302-883-8020
Mailing address:
  • Phone: 302-674-2616
  • Fax: 302-883-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0009783
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0002870
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0D01490
License Number StateDE

VIII. Authorized Official

Name: DR. JANAKI KAZA
Title or Position: PRESIDENT
Credential:
Phone: 302-674-2616