Provider Demographics
NPI:1194776377
Name:BAIG, MIRZA KHALID M (MD)
Entity type:Individual
Prefix:
First Name:MIRZA KHALID
Middle Name:M
Last Name:BAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4001 VOLLMER RD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-3168
Mailing Address - Country:US
Mailing Address - Phone:708-481-8883
Mailing Address - Fax:708-481-2917
Practice Address - Street 1:4001 VOLLMER RD
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-3168
Practice Address - Country:US
Practice Address - Phone:708-481-8883
Practice Address - Fax:708-481-2917
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL534410551OtherMEDICARE PIN LOCALITY 16
IL1700824455OtherGROUP NPI
IL534400452OtherMEDICARE PIN LOCALITY 15
IL36-2169147OtherGROUP TAX ID
IL534410551OtherMEDICARE PIN LOCALITY 16
ILP00006257Medicare PIN