Provider Demographics
NPI:1679868707
Name:BAIG, MIRZA A (MD)
Entity type:Individual
Prefix:
First Name:MIRZA
Middle Name:A
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 1:350 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-4911
Mailing Address - Country:US
Mailing Address - Phone:630-940-9573
Mailing Address - Fax:630-596-2319
Practice Address - Street 1:350 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-4911
Practice Address - Country:US
Practice Address - Phone:630-940-9573
Practice Address - Fax:630-596-2319
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2025-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400141463Medicare PIN