Provider Demographics
NPI:1861554073
Name:VIRJI, AYAZ (MD)
Entity type:Individual
Prefix:DR
First Name:AYAZ
Middle Name:
Last Name:VIRJI
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 1:1282 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232-2333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1282 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232-2333
Practice Address - Country:US
Practice Address - Phone:320-769-4323
Practice Address - Fax:320-769-2972
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD149619OtherMEDICARE GROUP NUMBER
MD945LOtherMEDICARE GROUP NUMBER
MD945LOtherMEDICARE GROUP NUMBER
PA213839YEBK - 213827Medicare PIN