Provider Demographics
NPI:1114184645
Name:MIRZA, QASIM MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:QASIM
Middle Name:MOHAMMAD
Last Name:MIRZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 1000 DEPT 457
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-275-3662
Mailing Address - Fax:901-271-0155
Practice Address - Street 1:1325 EASTMORELAND AVE STE 370
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7542
Practice Address - Country:US
Practice Address - Phone:901-758-7888
Practice Address - Fax:901-387-5153
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM8187207R00000X
OK27399207RP1001X
TN55594207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine