Provider Demographics
NPI:1669658308
Name:WAJAHAT MIRZA MD SC
Entity Type:Organization
Organization Name:WAJAHAT MIRZA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAJAHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-543-6814
Mailing Address - Street 1:1170 E BELVIDERE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2061
Mailing Address - Country:US
Mailing Address - Phone:847-543-6814
Mailing Address - Fax:847-543-0787
Practice Address - Street 1:1170 E BELVIDERE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2061
Practice Address - Country:US
Practice Address - Phone:847-543-6814
Practice Address - Fax:847-543-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty