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General NPI Number Information
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NPI Number | 1841453958
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Entity Type | Individual
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Provider Name | KHURRAM R MIRZA MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 10500 MONTGOMERY RD
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City | MONTGOMERY
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State | OH
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Zip | 45242-4402
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Country | US
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Telephone | 513-865-2246
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Fax |
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Provider Business Mailing Address
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Address Line | 4685 FOREST AVE
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City | CINCINNATI
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State | OH
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Zip | 45212-3397
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35.142113
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2008016537
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 35.142113
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 30999
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License Number State | NE
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