Provider Demographics
NPI:1073521209
Name:BAIG, MIRZA M (DPM)
Entity Type:Individual
Prefix:DR
First Name:MIRZA
Middle Name:M
Last Name:BAIG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13244 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1415
Mailing Address - Country:US
Mailing Address - Phone:313-581-4450
Mailing Address - Fax:313-581-7560
Practice Address - Street 1:13111 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3781
Practice Address - Country:US
Practice Address - Phone:313-865-2800
Practice Address - Fax:313-581-7560
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001432213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932198Medicaid
5825226Medicare ID - Type Unspecified
U21256Medicare UPIN
MIP23410008Medicare PIN