1598786436 NPI number — HARSHA KAZA MD

Table of content: HARSHA KAZA MD (NPI 1598786436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598786436 NPI number — HARSHA KAZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAZA
Provider First Name:
HARSHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598786436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 W FOREST HOME AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53215-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3115 LEWIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZION
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60099-3099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-746-3752
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036-110833 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 46268 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13561 . This is a "DEAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1043509 . This is a "PHYSICIANS PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390808509 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90002361 . This is a "WEA INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390808509 . This is a "WPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390808509 . This is a "CT GENERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34466000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00151657 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34466000 . This is a "HIRSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390808509CW . This is a "UNITY" identifier . This identifiers is of the category "OTHER".




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