Provider Demographics
NPI:1629292131
Name:DR SANJIDA MIRZA MD SC
Entity Type:Organization
Organization Name:DR SANJIDA MIRZA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-842-6547
Mailing Address - Street 1:849 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1065
Mailing Address - Country:US
Mailing Address - Phone:312-842-3547
Mailing Address - Fax:312-842-1878
Practice Address - Street 1:337 E 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3951
Practice Address - Country:US
Practice Address - Phone:312-842-3547
Practice Address - Fax:312-842-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty