Active NPI
Medo Mirza, MD, PHD
- Pediatric Surgery Physician
- Mesa, AZ
National Provider Identifier
1528038478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- 17426
- Practice address
- 1432 S Dobson Rd
Suite 301
Mesa, AZ 85202-4768 - Phone
- (480) 464-9400
- Fax
- (480) 464-9401
- NPI assigned
- Jan 24, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatric Surgery Physician | 2086S0120X | 17426 | AZ | Primary |
Addresses
Primary practice location
1432 S Dobson Rd
Suite 301
Mesa, AZ 85202-4768
Mailing address
1432 S Dobson Rd
Suite 301
Mesa, AZ 85202-4768
Phone (480) 464-9400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27694001 | Medicaid | AZ | |
| 27694001 | Other | AZ | AHCCCS |
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, Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240444800000",
"number": "1528038478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1432 S DOBSON RD",
"address_2": "SUITE 301",
"city": "MESA",
"state": "AZ",
"postal_code": "852024768",
"telephone_number": "480-464-9400",
"fax_number": "480-464-9401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1432 S DOBSON RD",
"address_2": "SUITE 301",
"city": "MESA",
"state": "AZ",
"postal_code": "852024768",
"telephone_number": "480-464-9400",
"fax_number": "480-464-9401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRZA",
"first_name": "MEDO",
"name_prefix": "Dr.",
"credential": "MD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-24",
"last_updated": "2009-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "AZ",
"license": "17426",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "27694001",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "27694001",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.