Ayezah Mir, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036-112854 Issued in IL

Practice address

700 W Jefferson St
Shorewood, IL 60404-7608

Phone

(815) 514-2040

Fax

(815) 741-2860

NPI assigned

Jun 1, 2006

Last updated

Aug 16, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amir216621@dulyhealthandcare.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fox River Pediatrics SC

  • Pediatrics Physician
  • Plano, IL
  • NPI 1710110473
  NPD Authorized official
• Dupage Medical Group LTD

  dba DuPage Medical Group

  • Multi-Specialty Clinic/Center
  • Downers Grove, IL
  • NPI 1801833983
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1740227388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771260",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W JEFFERSON ST",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604047608",
            "telephone_number": "815-514-2040",
            "fax_number": "815-741-2860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIR",
        "first_name": "AYEZAH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-112854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112854",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amir216621@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "address_1": "700 W Jefferson St",
            "city": "Shorewood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604047608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Michel, NP
• Midwest Upper Cervical
• Leigh Ann Miesner Hargreave, RDH
• John D. Mikuzis, DO
• Alisandra Militello
• Sidharth Mohan, MSD, BDS, BS
• Nancy A. Moore, CPNP
• Nathan Allen Moore, RBT
• Thomas John Moore, M.D.
• Lanie R Moreno, PT, DPT

• Pediatrics Physician in Shorewood, IL
• Providers in Shorewood, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.