Provider Demographics
NPI:1598979809
Name:BAIG, MIRZA ASIF (MD)
Entity Type:Individual
Prefix:
First Name:MIRZA
Middle Name:ASIF
Last Name:BAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3824 WABEER LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-763-9094
Mailing Address - Fax:
Practice Address - Street 1:4210 PONTIAC LAKE ROAD
Practice Address - Street 2:WATERFORD PEDS
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328
Practice Address - Country:US
Practice Address - Phone:248-673-1520
Practice Address - Fax:248-673-1017
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301403376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1377894Medicaid
MIB49090Medicare ID - Type Unspecified