Provider Demographics
NPI:1285720490
Name:BAIG, MIRZA OMER MAHMOOD (MD)
Entity type:Individual
Prefix:DR
First Name:MIRZA OMER
Middle Name:MAHMOOD
Last Name:BAIG
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 1:29624 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1296
Mailing Address - Country:US
Mailing Address - Phone:608-741-7652
Mailing Address - Fax:608-743-3260
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2982
Practice Address - Country:US
Practice Address - Phone:608-756-6868
Practice Address - Fax:608-756-6289
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110972207RI0200X
IA36686207RI0200X
WI61590207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1285720490Medicaid
IL347713004Medicare PIN
IA1285720490Medicaid
IAI10610001Medicare PIN