Provider Demographics
NPI:1639534654
Name:WAQAR ULISLAM MIRZA MD
Entity Type:Organization
Organization Name:WAQAR ULISLAM MIRZA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-628-1408
Mailing Address - Street 1:PO BOX 844010
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4010
Mailing Address - Country:US
Mailing Address - Phone:314-628-1408
Mailing Address - Fax:314-336-0562
Practice Address - Street 1:12277 DE PAUL DR
Practice Address - Street 2:SUITE 401
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2516
Practice Address - Country:US
Practice Address - Phone:314-628-1408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4N722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty