1568420040 NPI number — REZA S SAZGARI MD

Table of content: REZA S SAZGARI MD (NPI 1568420040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568420040 NPI number — REZA S SAZGARI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAZGARI
Provider First Name:
REZA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1568420040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23625 COMMERCE PARK
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-255-5700
Provider Business Mailing Address Fax Number:
216-255-5701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32227 ARLINGTON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48025-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-953-4703
Provider Business Practice Location Address Fax Number:
216-255-5701
Provider Enumeration Date:
05/03/2006

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: 2085R0202X , with the licence number:  4301074768 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4930796 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700F340300 . This is a "BCBS PROF GRP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2085R020X . This is a "TAXONOMY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2905762 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: I08753 . This is a "UPIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700E021910 . This is a "BCBS PROF GRP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1620742 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383162435 . This is a "TAX ID COMMERCIAL INSURANCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: RS074768 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700E021830 . This is a "BCBS PROF GRP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4769421 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5968608 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00433250 . This is a "GBA PALMETTO RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com