Active NPI
Sanjida Mirza, MD
- General Practice Physician
- Chicago, IL
National Provider Identifier
1174564199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 036066426
- Practice address
- 337 E 35TH St
Chicago, IL 60616 - Phone
- (312) 842-3547
- Fax
- (312) 842-1878
- NPI assigned
- Jun 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 036066426 | IL | Primary |
Addresses
Primary practice location
337 E 35TH St
Chicago, IL 60616
Mailing address
849 Oak Wood Dr
West Mont, IL 60559
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1634708 | Other | IL | BCBS |
| 036066426 | Medicaid | IL | |
| P00166625 | Other | IL | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036066426 | IL | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230595200000",
"number": "1174564199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "849 OAK WOOD DR",
"city": "WEST MONT",
"state": "IL",
"postal_code": "60559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "337 E 35TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60616",
"telephone_number": "312-842-3547",
"fax_number": "312-842-1878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRZA",
"first_name": "SANJIDA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-09",
"last_updated": "2008-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IL",
"license": "036066426",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1634708",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036066426",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00166625",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.