Provider Demographics
NPI:1649949447
Name:SHAHZAIB MIRZA MD MEDICAL PARTNERS PA
Entity type:Organization
Organization Name:SHAHZAIB MIRZA MD MEDICAL PARTNERS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHZAIB
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:929-228-9657
Mailing Address - Street 1:2104 W FIRST ST APT 2704
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3274
Mailing Address - Country:US
Mailing Address - Phone:929-228-9657
Mailing Address - Fax:
Practice Address - Street 1:19910 S TAMIAMI TRL STE C
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-4140
Practice Address - Country:US
Practice Address - Phone:929-228-9657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1225467467Medicaid
FL1649949447Medicaid