Basic Information
| Provider Information | |||||||||
| NPI: | 1841277670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAZLAUSKAS | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7452 FULTON DR NW | ||||||||
| Address2: | STE. B | ||||||||
| City: | MASSILLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446469393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308334596 | ||||||||
| FaxNumber: | 3308331817 | ||||||||
| Practice Location | |||||||||
| Address1: | 7452 FULTON DR NW | ||||||||
| Address2: | STE. B | ||||||||
| City: | MASSILLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446469393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308334596 | ||||||||
| FaxNumber: | 3308331817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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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 | 208000000X | 35061459 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0823345 | 05 | OH | MEDICAID |