Individual
BASAVAPUNNA R KAZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 DOCTORS DR, SPRINGHILL, LA 71075-4528
(318) 539-3809
(318) 539-4189
Mailing address
PO BOX 158, SPRINGHILL, LA 71075-0158
(318) 539-3809
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
10941R
LA
2084P0805X
Geriatric Psychiatry Physician
10941R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548596
—
LA
05
—
156295001
—
AR
Enumeration date
07/21/2005
Last updated
01/14/2010
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