Healthcare Provider Details

I. General information

NPI: 1013666528
Provider Name (Legal Business Name): BILAL MIRZA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W COCOA BEACH CSWY
COCOA BEACH FL
32931-5595
US

IV. Provider business mailing address

701 W COCOA BEACH CSWY
COCOA BEACH FL
32931-5595
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-1771
  • Fax: 321-434-1775
Mailing address:
  • Phone: 321-434-1771
  • Fax: 321-434-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS21954
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS21954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: