Provider Demographics
NPI:1104847862
Name:RAZA, SYED T (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:T
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0103
Mailing Address - Country:US
Mailing Address - Phone:812-542-1880
Mailing Address - Fax:812-542-1891
Practice Address - Street 1:1919 STATE STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6806
Practice Address - Country:US
Practice Address - Phone:812-542-1880
Practice Address - Fax:812-542-1891
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01055970A207RC0000X, 207RI0011X
KY32779207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7693352OtherAETNA
KY7959861OtherCIGNA
KY000000482692OtherANTHEM BCBS
KY1187455OtherCHA
IN200366430Medicaid
KY2751206000OtherPASSPORT ADVANTAGE
299856OtherFEDERAL BLACK LUNG PROGRA
KY64045966Medicaid
012970OtherSIHO
KYP00342895OtherRAILROAD MEDICARE
KY50011228OtherPASSPORT HEALTH PLAN
KY0874909Medicare ID - Type Unspecified
IN084820FMedicare ID - Type Unspecified
IN200366430Medicaid
KY000000482692OtherANTHEM BCBS
KYH00942Medicare UPIN
KYK014571Medicare PIN