MEDICARE: YAZDI N. AMARIA,M.D.,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301049704	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1018312	OTHER	MI	MCLAREN HEALTH PLAN
2	0005218428	OTHER		AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	13039	OTHER	MI	HEALTH PLAN OF MICHIGAN
5	0107500492	OTHER	MI	BLUE CROSS BLUE SHIELD
6	113029	OTHER	MI	GREAT LAKES HEALTH PLAN

General Provider Information

NPI Number	:	1306010145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAZDI N. AMARIA,M.D.,P.C.

Provider Business Mailing Address
First Line	:	111 S MONROE ST
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-1728
Country	:	US
Telephone Number	:	269-651-3218
Fax Number	:	269-651-3219

Provider Business Practice Location Address
First Line	:	111 S MONROE ST
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-1728
Country	:	US
Telephone Number	:	269-651-3218
Fax Number	:	269-651-3219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YAZDI N AMARIA
Credential	:	M.D.
Telephone Number	:	269-651-3218

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	05/27/2008

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Directions to “YAZDI N. AMARIA,M.D.,P.C. ” Practice Location

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