Provider Demographics
NPI:1043250053
Name:MIRZA, NAJMA A (MD)
Entity type:Individual
Prefix:
First Name:NAJMA
Middle Name:A
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CHATHAM LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2349
Mailing Address - Country:US
Mailing Address - Phone:773-544-9912
Mailing Address - Fax:847-626-0819
Practice Address - Street 1:3701 JARVIS AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-4019
Practice Address - Country:US
Practice Address - Phone:847-626-0800
Practice Address - Fax:847-626-0819
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360572542085R0202X
IN01067863A2085R0202X
MIL21242422085R0202X
MIM117280022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057254Medicaid
WIK37990Medicare PIN
MIMII728002Medicare PIN
ILK45868Medicare PIN
ILD16324Medicare UPIN
INM400024444Medicare PIN