Healthcare Provider Details

I. General information

NPI: 1063907046
Provider Name (Legal Business Name): SUMAN KAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS RD STE 50
DETROIT MI
48236-2166
US

IV. Provider business mailing address

1000 E MOUNTAIN DR
WILKES BARRE PA
18711-0027
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7774
  • Fax: 313-343-8747
Mailing address:
  • Phone: 570-808-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD480514
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301116003
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD480514
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: