Individual
SANJIDA MIRZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
337 E 35TH ST, CHICAGO, IL 60616
(312) 842-3547
(312) 842-1878
Mailing address
849 OAK WOOD DR, WEST MONT, IL 60559
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036066426
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036066426
—
IL
01
—
1634708
BCBS
IL
01
—
P00166625
RAILROAD MEDICARE
IL
Enumeration date
06/09/2006
Last updated
12/30/2008
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