Provider Demographics
NPI:1851881296
Name:MIRZA, NOVEERA ABEER (MD)
Entity Type:Individual
Prefix:
First Name:NOVEERA
Middle Name:ABEER
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 S DELANO CT E STE A201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3482
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:312-694-9287
Practice Address - Street 1:1135 S DELANO CT E STE A201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3482
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-694-9287
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336116490207Q00000X
IL036157102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine