Provider Demographics
NPI:1205521069
Name:MIRZA, HUMZA NADEEM (MD, MS)
Entity type:Individual
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First Name:HUMZA
Middle Name:NADEEM
Last Name:MIRZA
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Gender:M
Credentials:MD, MS
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Mailing Address - Street 1:275 MICHIGAN ST NE FL 9
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2531
Mailing Address - Country:US
Mailing Address - Phone:616-391-6243
Mailing Address - Fax:616-391-8612
Practice Address - Street 1:275 MICHIGAN ST NE FL 9
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2531
Practice Address - Country:US
Practice Address - Phone:616-391-6243
Practice Address - Fax:616-391-8612
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2025-02-26
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Provider Licenses
StateLicense IDTaxonomies
MI4351051286208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery