Provider Demographics
NPI:1326208513
Name:MIRZA, LUBNA (MD)
Entity Type:Individual
Prefix:
First Name:LUBNA
Middle Name:
Last Name:MIRZA
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:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-5700
Mailing Address - Fax:405-307-5721
Practice Address - Street 1:3400 W TECUMSEH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1810
Practice Address - Country:US
Practice Address - Phone:405-307-5720
Practice Address - Fax:405-307-5721
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26232207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200211860AMedicaid
OKOKA102300Medicare PIN