Basic Information
| Provider Information | |||||||||
| NPI: | 1487227476 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANGELA KAZA MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 S PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481987914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345471174 | ||||||||
| FaxNumber: | 7345471161 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 S PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481987914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345471174 | ||||||||
| FaxNumber: | 7345471161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2021 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | KAZA | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7347099032 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4301503029 | 01 | MI | LICENSE NUMBER | OTHER |