Provider Demographics
NPI:1265404073
Name:BAIG, MIRZA BASIT (MD)
Entity type:Individual
Prefix:
First Name:MIRZA
Middle Name:BASIT
Last Name:BAIG
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 1:300 W GOOD SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MN
Mailing Address - Zip Code:56762-1412
Mailing Address - Country:US
Mailing Address - Phone:218-745-4211
Mailing Address - Fax:218-745-3254
Practice Address - Street 1:300 W GOOD SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MN
Practice Address - Zip Code:56762-1412
Practice Address - Country:US
Practice Address - Phone:218-745-4211
Practice Address - Fax:218-745-3254
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42393207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN960827300Medicaid
MN960827300Medicaid
MNH06897Medicare UPIN
MN110006962Medicare PIN
ND711885Medicare PIN
MN110009483Medicare PIN