Provider Demographics
NPI:1447399431
Name:MIRZA, MOBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOBEN
Middle Name:
Last Name:MIRZA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3901 RAINBOW BLVD MS 3016
Mailing Address - Street 2:DEPT OF UROLOGY - UNIV OF KS MEDICAL CTR
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-7564
Mailing Address - Fax:913-588-6668
Practice Address - Street 1:3901 RAINBOW BLVD MS 3016
Practice Address - Street 2:DEPT OF UROLOGY - UNIV OF KS MEDICAL CTR
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-7564
Practice Address - Fax:913-588-6668
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2004-0457208800000X
MO2009011507208800000X
KS04-33818208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200608190AMedicaid