Individual
WAQAR U. MIRZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12266 DE PAUL DRIVE, SUITE 225, BRIDGETON, MO 63044-2514
(314) 881-2700
(314) 881-2706
Mailing address
12266 DE PAUL DR, SUITE 225, BRIDGETON, MO 63044-2514
(314) 344-7555
(314) 344-7665
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
R4N72
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202871018
—
MO
01
—
214050163
MEDICARE DEPAUL/SSM HC
—
Enumeration date
06/03/2006
Last updated
08/14/2008
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