MEDICARE: GULNAZ MIRZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME0076874	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2787055	OTHER	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7013340	OTHER	AETNA
4	49219	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1215904354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GULNAZ MIRZA MD

Provider Business Mailing Address
First Line	:	8190 S JOG RD
Second Line	:	SUITE 120
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2912
Country	:	US
Telephone Number	:	561-964-1411
Fax Number	:	561-964-3039

Provider Business Practice Location Address
First Line	:	8190 S JOG RD
Second Line	:	SUITE 120
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2912
Country	:	US
Telephone Number	:	561-964-1411
Fax Number	:	561-964-3039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/13/2016

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Directions to “ GULNAZ MIRZA MD” Practice Location

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