MEDICARE: BASAVAPUNNA R KAZA M.D.

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	2084P0800X	Psychiatry Physician	10941R	LA
2	2084P0805X	Geriatric Psychiatry Physician	10941R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447250329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASAVAPUNNA R KAZA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:
City	:	SPRINGHILL
State	:	LA
Zip	:	71075-0158
Country	:	US
Telephone Number	:	318-539-3809
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 DOCTORS DR
Second Line	:
City	:	SPRINGHILL
State	:	LA
Zip	:	71075-4528
Country	:	US
Telephone Number	:	318-539-3809
Fax Number	:	318-539-4189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	01/14/2010

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