Organization
CRITICAL CARE MEDICINE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IMRAN AZAM MIRZA MD (OWNER)
(856) 381-9598
Entity
Organization
Contact information
Practice address
1930 S BROAD ST UNIT 12, PHILADELPHIA, PA 19145-2328
(267) 570-5200
Mailing address
PO BOX 69, MICKLETON, NJ 08056-0069
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD431989
PA
Other
Enumeration date
08/21/2017
Last updated
06/16/2018
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