Provider Demographics
NPI:1013076553
Name:MIRZA, RAHAT U (MD)
Entity Type:Individual
Prefix:
First Name:RAHAT
Middle Name:U
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:#606-804 3RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CALGARY
Mailing Address - State:AB
Mailing Address - Zip Code:T2P0G9
Mailing Address - Country:CA
Mailing Address - Phone:780-449-1481
Mailing Address - Fax:
Practice Address - Street 1:# 55, 52304 RR 233
Practice Address - Street 2:
Practice Address - City:SHERWOOD PARK
Practice Address - State:AB
Practice Address - Zip Code:T8B1C9
Practice Address - Country:CA
Practice Address - Phone:780-449-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA82202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine