MEDICARE: NADEEM M 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	2084P0800X	Psychiatry Physician	4301086227	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700H060020	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437159597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADEEM M MIRZA MD

Provider Business Mailing Address
First Line	:	404 HAZEN ST
Second Line	:	SUITE 104
City	:	PAW PAW
State	:	MI
Zip	:	49079-1040
Country	:	US
Telephone Number	:	269-657-1595
Fax Number	:	269-657-1534

Provider Business Practice Location Address
First Line	:	404 HAZEN ST
Second Line	:	SUITE 104
City	:	PAW PAW
State	:	MI
Zip	:	49079-1040
Country	:	US
Telephone Number	:	269-657-1595
Fax Number	:	269-657-1534

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/27/2023

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