MEDICARE: THOMAS MIRZAI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	20A6865	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447243886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MIRZAI D.O.

Provider Business Mailing Address
First Line	:	3815 E BELL RD
Second Line	:	4400
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2122
Country	:	US
Telephone Number	:	602-788-7211
Fax Number	:	602-788-1890

Provider Business Practice Location Address
First Line	:	3815 E BELL RD
Second Line	:	4400
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2122
Country	:	US
Telephone Number	:	602-788-7211
Fax Number	:	602-788-1890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/27/2016

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Directions to “ THOMAS MIRZAI D.O.” Practice Location

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