Provider Demographics
NPI:1821452970
Name:NIAZI, ISMATT REZA (MD)
Entity type:Individual
Prefix:
First Name:ISMATT
Middle Name:REZA
Last Name:NIAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N 8TH ST STE 418
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-1359
Mailing Address - Country:US
Mailing Address - Phone:402-817-5813
Mailing Address - Fax:308-318-2954
Practice Address - Street 1:140 N 8TH ST STE 418
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-1359
Practice Address - Country:US
Practice Address - Phone:402-817-5813
Practice Address - Fax:308-318-2953
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE334362084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty