Healthcare Provider Details

I. General information

NPI: 1568420040
Provider Name (Legal Business Name): REZA S SAZGARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32227 ARLINGTON DRIVE
BEVERLY HILLS MI
48025-4217
US

IV. Provider business mailing address

23625 COMMERCE PARK STE 204
BEACHWOOD OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 248-953-4703
  • Fax: 216-255-5701
Mailing address:
  • Phone: 216-255-5700
  • Fax: 216-255-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301074768
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: