Healthcare Provider Details

I. General information

NPI: 1871661348
Provider Name (Legal Business Name): RAMARAO KAZA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R SUITE 809
DETROIT MI
48201
US

IV. Provider business mailing address

4160 JOHN R SUITE 809
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-2700
  • Fax: 313-831-0430
Mailing address:
  • Phone: 313-831-2700
  • Fax: 313-831-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301033043
License Number StateMI

VIII. Authorized Official

Name: RAMARAO KAZA
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 313-831-2700