Individual
MOHAMMED AZHER MIRZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4045 NE LAKEWOOD WAY, STE 130, LEES SUMMIT, MO 64064-1995
(816) 228-5335
(816) 228-7663
Mailing address
4045 NE LAKEWOOD WAY, STE 130, LEES SUMMIT, MO 64064-1995
(816) 228-5335
(816) 228-7663
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
R1C10
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006543B
MEDICARE ID
MO
01
—
100419680A
MEDICAID
KS
01
—
10731160
BCBS OF KC
MO
05
—
H201651387
—
MO
01
—
MA4861001
MEDICARE ID
MO
Enumeration date
10/16/2006
Last updated
02/11/2016
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