Healthcare Provider Details

I. General information

NPI: 1134128036
Provider Name (Legal Business Name): IRFAN A MIRZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE SUITE ONE
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

7447 W TALCOTT AVE SUITE ONE
CHICAGO IL
60631-3745
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-2354
  • Fax:
Mailing address:
  • Phone: 773-774-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036-098382
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: