Healthcare Provider Details

I. General information

NPI: 1679597652
Provider Name (Legal Business Name): SRINIVAS R KAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 PARRISH ST SUITE 250
CANANDAIGUA NY
14424-1795
US

IV. Provider business mailing address

229 PARRISH ST SUITE 250
CANANDAIGUA NY
14424-1795
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-8800
  • Fax: 585-394-5942
Mailing address:
  • Phone: 585-394-8800
  • Fax: 585-394-5942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number229404
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number229404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: