Basic Information
Provider Information | |||||||||
NPI: | 1437156015 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MIRZA | ||||||||
FirstName: | MUHAMMED | ||||||||
MiddleName: | RASHID | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 430 | ||||||||
Address2: |   | ||||||||
City: | STANDISH | ||||||||
State: | MI | ||||||||
PostalCode: | 486580430 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9898463555 | ||||||||
FaxNumber: | 9898463546 | ||||||||
Practice Location | |||||||||
Address1: | 805 W CEDAR ST | ||||||||
Address2: |   | ||||||||
City: | STANDISH | ||||||||
State: | MI | ||||||||
PostalCode: | 486589526 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9898463555 | ||||||||
FaxNumber: | 9898463546 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/28/2005 | ||||||||
LastUpdateDate: | 12/23/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301064585 | MI | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 4224665 | 05 | MI |   | MEDICAID | 0100647012 | 01 | MI | BCBSM | OTHER | 64RO1184 | 01 | MI | HEALTH PLUS | OTHER |