Provider Demographics
NPI:1750332284
Name:BAIG, MIRZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRZA
Middle Name:
Last Name:BAIG
Suffix:
Gender:M
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:PO BOX 22112
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-9402
Mailing Address - Country:US
Mailing Address - Phone:515-210-2806
Mailing Address - Fax:
Practice Address - Street 1:3520 BEAVER AVE
Practice Address - Street 2:SUITE G
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3264
Practice Address - Country:US
Practice Address - Phone:515-277-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34037207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1418400Medicaid
G79842Medicare UPIN
IAI9705Medicare ID - Type Unspecified