Provider Demographics
NPI:1427328590
Name:DR ADILAKSHMI KAZA MD LLC
Entity type:Organization
Organization Name:DR ADILAKSHMI KAZA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADILAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-945-4611
Mailing Address - Street 1:4555 W SCHROEDER DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1496
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3225
Practice Address - Street 1:6127 GREEN BAY RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2946
Practice Address - Country:US
Practice Address - Phone:262-945-4611
Practice Address - Fax:262-654-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54378-20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty