Provider Demographics
NPI:1669591012
Name:MIRZA, ARIF K (MD)
Entity type:Individual
Prefix:DR
First Name:ARIF
Middle Name:K
Last Name:MIRZA
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 1:1910 PACIFIC AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4540
Mailing Address - Country:US
Mailing Address - Phone:901-730-0575
Mailing Address - Fax:901-730-0389
Practice Address - Street 1:7505 CAPITAL DR
Practice Address - Street 2:GERMANTOWN PRIVATE PSYCHIATRY PLLC
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-730-0575
Practice Address - Fax:901-730-0389
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS287072084P0804X
TXT22212084P0804X
ARE-57282084P0804X
OK380572084P0804X
TN453932084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR176320001Medicaid
TN1526587Medicaid