Provider Demographics
NPI:1467628388
Name:MIR, IMRAN
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:
Last Name:MIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:IMRAN
Other - Middle Name:
Other - Last Name:MIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-583-6800
Mailing Address - Fax:989-583-6915
Practice Address - Street 1:1000 HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5303
Practice Address - Country:US
Practice Address - Phone:989-583-6838
Practice Address - Fax:989-583-6915
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1467628388Medicaid
MIG36021053Medicare PIN