Provider Demographics
NPI:1568580272
Name:MUHAMMED R MIRZA MD
Entity Type:Organization
Organization Name:MUHAMMED R MIRZA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-846-3555
Mailing Address - Street 1:805 W CEDAR STREET
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658
Mailing Address - Country:US
Mailing Address - Phone:989-846-3555
Mailing Address - Fax:989-846-3546
Practice Address - Street 1:805 W CEDAR STREET
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658
Practice Address - Country:US
Practice Address - Phone:989-846-3555
Practice Address - Fax:989-846-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301064585OtherLICENSE NUMBER
MI1437156015OtherNPI INDIVIDUAL
MI0100647012OtherBLUE CROSS BLUE SHIELD MI
MI4224665Medicaid
MI64R01184OtherHEALTH PLUS ID
MI4301064585OtherLICENSE NUMBER
MI4224665Medicaid