Provider Demographics
NPI:1578898920
Name:MUHAMMAD ALI MIRZA, MD, P.A.
Entity Type:Organization
Organization Name:MUHAMMAD ALI MIRZA, MD, P.A.
Other - Org Name:CARROLLTON PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-483-3292
Mailing Address - Street 1:4300 N JOSEY LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4744
Mailing Address - Country:US
Mailing Address - Phone:214-483-3292
Mailing Address - Fax:214-483-3286
Practice Address - Street 1:4300 N JOSEY LN
Practice Address - Street 2:SUITE 110
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4744
Practice Address - Country:US
Practice Address - Phone:214-483-3292
Practice Address - Fax:214-483-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0404208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111510704Medicaid
TX111510704Medicaid