Provider Demographics
NPI:1083357552
Name:MIRZA, TUBA SOHAIL (DO)
Entity Type:Individual
Prefix:
First Name:TUBA
Middle Name:SOHAIL
Last Name:MIRZA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30117 SCHOENHERR RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6854
Mailing Address - Country:US
Mailing Address - Phone:586-738-9470
Mailing Address - Fax:586-738-9469
Practice Address - Street 1:30117 SCHOENHERR RD STE 400
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6854
Practice Address - Country:US
Practice Address - Phone:586-738-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program