Healthcare Provider Details

I. General information

NPI: 1023275526
Provider Name (Legal Business Name): MIRZA SHADMAN BAIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 INWOOD RD 5TH FL, WEST CAMPUS BLDG 3
DALLAS TX
75390-7539
US

IV. Provider business mailing address

5959 HARRY HINES BLVD POB 1 SUITE 620
DALLAS TX
75390-0001
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-0538
  • Fax: 214-645-0536
Mailing address:
  • Phone: 214-645-0545
  • Fax: 214-645-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA79653
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberP1961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: