Individual
MANSOOR HUSSAIN MIRZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2414 KOHLER MEMORIAL DRIVE, SHEBOYGAN, WI 53081-3129
(920) 457-4461
(920) 459-1483
Mailing address
3600 ROUTE 66 FL 3, NEPTUNE, NJ 07753-2645
(732) 807-0877
(201) 751-1680
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
48060
WI
208M00000X
Hospitalist Physician
48060
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132679
CIGNA
WI
05
—
34652100
—
WI
01
—
390806395002
TRICARE
WI
01
—
P00138179
NETWORK HEALTH PLAN
WI
01
—
P00252461
RAILROAD MEDICARE
WV
Enumeration date
08/29/2006
Last updated
03/20/2024
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