Provider Demographics
NPI:1215904354
Name:MIRZA, GULNAZ (MD)
Entity type:Individual
Prefix:
First Name:GULNAZ
Middle Name:
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GULNAZ
Other - Middle Name:
Other - Last Name:AKHTAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8190 S JOG RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2912
Mailing Address - Country:US
Mailing Address - Phone:561-964-1411
Mailing Address - Fax:561-964-3039
Practice Address - Street 1:8190 S JOG RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2912
Practice Address - Country:US
Practice Address - Phone:561-964-1411
Practice Address - Fax:561-964-3039
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076874207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
2787055OtherAETNA
FL262162200Medicaid
7013340OtherAETNA
49219OtherBLUE CROSS BLUE SHIELD
FL49219AMedicare ID - Type Unspecified
49219OtherBLUE CROSS BLUE SHIELD
FL49219Medicare ID - Type Unspecified