Provider Demographics
NPI:1548269822
Name:MIRZA, MUHAMMAD A (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:A
Last Name:MIRZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N JOSEY LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4602
Mailing Address - Country:US
Mailing Address - Phone:214-482-3292
Mailing Address - Fax:214-483-3286
Practice Address - Street 1:4300 N.JOSEY LN.
Practice Address - Street 2:SUITE 110
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-5338
Practice Address - Country:US
Practice Address - Phone:214-482-3292
Practice Address - Fax:214-483-3286
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2008-02-15
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TXJ0404208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F08756Medicare UPIN