Basic Information
| Provider Information | |||||||||
| NPI: | 1629323746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RZASA | ||||||||
| FirstName: | CALLIE | ||||||||
| MiddleName: | LEEANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 138 LEADER AVE | ||||||||
| Address2: | RM 252 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405063215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235962 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 138 LEADER AVE | ||||||||
| Address2: | RM 252 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405063215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235962 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2012 | ||||||||
| LastUpdateDate: | 12/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | TP234 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 2080P0202X | A118429 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 390200000X | A118429 | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2080P0202X | 49619 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.