Provider Demographics
NPI:1568561678
Name:MIRZA, MUHAMMAD AZIM (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:AZIM
Last Name:MIRZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 E 5TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3135
Mailing Address - Country:US
Mailing Address - Phone:636-432-0055
Mailing Address - Fax:636-390-7332
Practice Address - Street 1:851 E 5TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3135
Practice Address - Country:US
Practice Address - Phone:636-432-0055
Practice Address - Fax:636-390-7332
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2010004026207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology