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Individual

DR. AYEZAH MIR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
700 W JEFFERSON ST, SHOREWOOD, IL 60404-7608
(815) 514-2040
(815) 741-2860
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-112854
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036112854
IL
Enumeration date
06/01/2006
Last updated
08/16/2023
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