Basic Information
| Provider Information | |||||||||
| NPI: | 1558500587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIRZA | ||||||||
| FirstName: | IMRAN | ||||||||
| MiddleName: | HUMAYUN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17304 PRESTON RD STE 1400 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669318882 | ||||||||
| FaxNumber: | 8664068864 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 E SAUNDERS ST | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567965000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2009 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME113910 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | ME113910 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | P8055 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 01071271A | IN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 4301099750 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 79899 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.