Basic Information
| Provider Information | |||||||||
| NPI: | 1194776377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAIG | ||||||||
| FirstName: | MIRZA KHALID | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 VOLLMER RD | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604613168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084818883 | ||||||||
| FaxNumber: | 7084812917 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 VOLLMER RD | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604613168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084818883 | ||||||||
| FaxNumber: | 7084812917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036065377 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 534410551 | 01 | IL | MEDICARE PIN LOCALITY 16 | OTHER | 1700824455 | 01 | IL | GROUP NPI | OTHER | 534400452 | 01 | IL | MEDICARE PIN LOCALITY 15 | OTHER | 36-2169147 | 01 | IL | GROUP TAX ID | OTHER |