Provider Demographics
NPI:1255510277
Name:MIRZA ASID BAIG MD
Entity type:Organization
Organization Name:MIRZA ASID BAIG MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:ASIF
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-852-5177
Mailing Address - Street 1:2502 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3817
Mailing Address - Country:US
Mailing Address - Phone:248-852-5177
Mailing Address - Fax:
Practice Address - Street 1:2502 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3817
Practice Address - Country:US
Practice Address - Phone:248-852-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301403376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1377894Medicaid