Healthcare Provider Details

I. General information

NPI: 1003308974
Provider Name (Legal Business Name): USMAN MIRZA HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 N 1ST ST STE A
HAMILTON MT
59840-2542
US

IV. Provider business mailing address

712 W SPRUCE ST
MISSOULA MT
59802-4025
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-4363
  • Fax:
Mailing address:
  • Phone: 208-840-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA-3382
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD-HAD-LIC-1450
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: