Provider Demographics
NPI:1366482937
Name:MIR, BATOOL (MD)
Entity Type:Individual
Prefix:DR
First Name:BATOOL
Middle Name:
Last Name:MIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:STE 202
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3820
Mailing Address - Fax:517-913-3821
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:STE 202
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3820
Practice Address - Fax:517-913-3821
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080153653OtherRAILROAD MEDICARE
MI1001916OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1001916OtherMCLAREN HEALTH PLAN-MEDICAID
MI0802300632OtherBCBS/BCN
MI4185880Medicaid
MI0M21440017OtherMEDICARE ADVANTAGE
MI200000002404OtherPHP
MI200000002404OtherPHP FAMILYCARE
MI1001916OtherMCLAREN HEALTH ADVANTAGE
MI5217612OtherAETNA
MI5217612OtherAETNA
MIM21440017Medicare PIN