Provider Demographics
NPI:1194794412
Name:KAZA, ADILAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:ADILAKSHMI
Middle Name:
Last Name:KAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11571 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4020 VENOY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1869
Practice Address - Country:US
Practice Address - Phone:734-722-7440
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069491207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A28954Medicare UPIN