MEDICARE: DR. AGNI MIRZA M.D.

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	207R00000X	Internal Medicine Physician	35. 092320	OH

General Provider Information

NPI Number	:	1588814727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AGNI MIRZA M.D.

Provider Business Mailing Address
First Line	:	1365 VILLA DR
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2901
Country	:	US
Telephone Number	:	216-381-5106
Fax Number	:

Provider Business Practice Location Address
First Line	:	7123 PEARL RD
Second Line	:	TEAMHEALTH MIDWEST, SUITE 201
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4975
Country	:	US
Telephone Number	:	800-842-0255
Fax Number	:	440-842-8835

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

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/24/2008

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