Healthcare Provider Details

I. General information

NPI: 1568580272
Provider Name (Legal Business Name): MUHAMMED R MIRZA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W CEDAR STREET
STANDISH MI
48658
US

IV. Provider business mailing address

805 W CEDAR STREET PO BOX 430
STANDISH MI
48658
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-3555
  • Fax: 989-846-3546
Mailing address:
  • Phone: 989-846-3555
  • Fax: 989-846-3546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301064585
License Number StateMI

VIII. Authorized Official

Name: DR. MUHAMMED R MIRZA
Title or Position: OWNER
Credential: MD
Phone: 989-846-3555