Provider Demographics
NPI:1720061492
Name:MAZ, MEHRDAD III (MD)
Entity type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:MAZ
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MEHRDAD
Other - Middle Name:
Other - Last Name:MAZLUMAZDEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6009
Mailing Address - Fax:913-588-8182
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6009
Practice Address - Fax:913-588-8182
Is Sole Proprietor?:No
Enumeration Date:2005-11-27
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34035207RR0500X
KS04-34968207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00231286OtherRAILROAD MEDICARE
AZ86080015085259C443OtherTRIWEST
AZ942864Medicaid
AZP00231286OtherRAILROAD MEDICARE
G77761Medicare UPIN