Provider Demographics
NPI: | 1871510800 |
---|---|
Name: | PIRZADA, YASMIN D (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | YASMIN |
Middle Name: | D |
Last Name: | PIRZADA |
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: | 2221 HAYES AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | FREMONT |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43420-2632 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 419-334-8943 |
Mailing Address - Fax: | 419-334-8619 |
Practice Address - Street 1: | 5734 FREMONT PIKE |
Practice Address - Street 2: | |
Practice Address - City: | STONY RIDGE |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43463-9507 |
Practice Address - Country: | US |
Practice Address - Phone: | 419-334-3869 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-16 |
Last Update Date: | 2021-07-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301084110 | 174400000X |
OH | 35084243 | 207RI0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
T09121521 | Other | GROUP MEDICARE PIN | |
MI | 465848710 | Medicaid | |
I17004 | Medicare UPIN | ||
T09121521 | Other | GROUP MEDICARE PIN |