Provider Demographics
NPI:1588814727
Name:MIRZA, AGNI (MD)
Entity Type:Individual
Prefix:DR
First Name:AGNI
Middle Name:
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 VILLA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2901
Mailing Address - Country:US
Mailing Address - Phone:216-381-5106
Mailing Address - Fax:
Practice Address - Street 1:7123 PEARL RD
Practice Address - Street 2:TEAMHEALTH MIDWEST, SUITE 201
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4975
Practice Address - Country:US
Practice Address - Phone:800-842-0255
Practice Address - Fax:440-842-8835
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 092320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine