Provider Demographics
NPI:1457319089
Name:MIRZA, TARIQ (MD)
Entity Type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:
Last Name:MIRZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12606 GREENVILLE AVE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1921
Mailing Address - Country:US
Mailing Address - Phone:214-575-5757
Mailing Address - Fax:214-575-5759
Practice Address - Street 1:12606 GREENVILLE AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1921
Practice Address - Country:US
Practice Address - Phone:214-575-5757
Practice Address - Fax:214-575-5759
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL84392080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine