Provider Demographics
NPI:1386697761
Name:RAZA, OVAIS (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:OVAIS
Middle Name:
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6687
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-6687
Mailing Address - Country:US
Mailing Address - Phone:812-277-9692
Mailing Address - Fax:812-277-9694
Practice Address - Street 1:3251 S SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-5277
Practice Address - Country:US
Practice Address - Phone:812-277-9692
Practice Address - Fax:812-277-9694
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044272A174400000X, 207R00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING16641Medicare UPIN