Provider Demographics
NPI:1982683801
Name:MIRZA, HUMAYUN (MD)
Entity Type:Individual
Prefix:
First Name:HUMAYUN
Middle Name:
Last Name:MIRZA
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 1:18400 KATY FWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1286
Mailing Address - Country:US
Mailing Address - Phone:713-464-7040
Mailing Address - Fax:713-464-7078
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:SUITE 270
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1287
Practice Address - Country:US
Practice Address - Phone:713-464-7040
Practice Address - Fax:713-464-7078
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6120207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157221601Medicaid
TX8A3420Medicare ID - Type Unspecified
G40681Medicare UPIN