Provider Demographics
NPI:1407022536
Name:MUZAFFAR MIRZA
Entity Type:Organization
Organization Name:MUZAFFAR MIRZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-548-0600
Mailing Address - Street 1:4501 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-3758
Mailing Address - Country:US
Mailing Address - Phone:773-548-0600
Mailing Address - Fax:773-548-0740
Practice Address - Street 1:4501 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3758
Practice Address - Country:US
Practice Address - Phone:773-548-0600
Practice Address - Fax:773-548-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019459261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental