Provider Demographics
NPI:1194947879
Name:BAIG, MIRZA N (MD, PHD)
Entity type:Individual
Prefix:
First Name:MIRZA
Middle Name:N
Last Name:BAIG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 VISION PARK BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3002
Mailing Address - Country:US
Mailing Address - Phone:855-457-7463
Mailing Address - Fax:855-356-3876
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:855-457-7463
Practice Address - Fax:855-356-3876
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH87550207T00000X
IA38482207T00000X
TXN8485207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA494695OtherCOVENTRY HEALTH CARE
IA165644OtherHEALTH ALLIANCE
IA494695OtherCOVENTRY HEALTH CARE
IA44067042Medicare PIN