Provider Demographics
NPI:1114603404
Name:AGHA, FIZZA (MD)
Entity Type:Individual
Prefix:
First Name:FIZZA
Middle Name:
Last Name:AGHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 WINDING RD APT 109
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-9813
Mailing Address - Country:US
Mailing Address - Phone:929-375-7748
Mailing Address - Fax:
Practice Address - Street 1:3443 FARR RD
Practice Address - Street 2:
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-8779
Practice Address - Country:US
Practice Address - Phone:231-727-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM1212353-14861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine