Provider Demographics
NPI:1417222985
Name:IQBAL M MIRZA MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:IQBAL M MIRZA MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IQBAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-655-2340
Mailing Address - Street 1:PO BOX 3612
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-1612
Mailing Address - Country:US
Mailing Address - Phone:408-655-2340
Mailing Address - Fax:408-741-8802
Practice Address - Street 1:555 KNOWLES DR
Practice Address - Street 2:115
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1549
Practice Address - Country:US
Practice Address - Phone:408-655-2340
Practice Address - Fax:408-741-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty