Provider Demographics
NPI:1003308974
Name:MIRZA, USMAN (HIS)
Entity Type:Individual
Prefix:MR
First Name:USMAN
Middle Name:
Last Name:MIRZA
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4025
Mailing Address - Country:US
Mailing Address - Phone:208-840-0025
Mailing Address - Fax:
Practice Address - Street 1:1720 N 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2542
Practice Address - Country:US
Practice Address - Phone:406-363-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHT-3351237600000X
MTHAD-HAD-LIC-1450237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDHT-3351OtherHEARING AID DEALER & FITTER