Individual
SHAKEELA F MIRZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
46591 ROMEO PLANK RD, SUITE 205, MACOMB, MI 48044-5742
(586) 226-6250
(586) 226-6255
Mailing address
46591 ROMEO PLANK RD, SUITE 205, MACOMB, MI 48044-5742
(586) 226-6250
(586) 226-6255
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301064234
MI
2080A0000X
Pediatric Adolescent Medicine Physician
4301064234
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E011720
BCBS GROUP NUMBER
MI
05
—
3383980
—
MI
05
—
4172282
—
MI
Enumeration date
05/12/2006
Last updated
03/01/2011
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