Provider Demographics
NPI:1619557170
Name:MIRZA, JAWAIRIA SAHAR K (MD)
Entity type:Individual
Prefix:DR
First Name:JAWAIRIA SAHAR
Middle Name:K
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3200 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9274
Mailing Address - Country:US
Mailing Address - Phone:262-334-5553
Mailing Address - Fax:262-836-7301
Practice Address - Street 1:3200 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9274
Practice Address - Country:US
Practice Address - Phone:262-334-5553
Practice Address - Fax:262-836-7301
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI84200207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1619557170Medicaid