Provider Demographics
NPI:1588629729
Name:WAZIRI, MIR AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MIR
Middle Name:AHMAD
Last Name:WAZIRI
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 1:212 W DALE STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703
Mailing Address - Country:US
Mailing Address - Phone:319-235-3050
Mailing Address - Fax:319-235-0021
Practice Address - Street 1:212 W DALE STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703
Practice Address - Country:US
Practice Address - Phone:319-235-3050
Practice Address - Fax:319-235-0021
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA272272080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0279836Medicaid
IA27936OtherBLUE CROSS BLUE SHIELD
E07341Medicare UPIN