NPIMap

Individual provider Active NPI

Shakeela F Mirza, MD

  • Pediatrics Physician
  • Macomb, MI
National Provider Identifier
1902856578
Registry record updated Mar 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301064234 Issued in MI
Practice address
46591 Romeo Plank Rd
Suite 205
Macomb, MI 48044-5742
Phone
(586) 226-6250
Fax
(586) 226-6255
NPI assigned
May 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301064234 MI Primary
Pediatric Adolescent Medicine Physician 2080A0000X 4301064234 MI

Addresses

Primary practice location

46591 Romeo Plank Rd
Suite 205
Macomb, MI 48044-5742

Mailing address

46591 Romeo Plank Rd
Suite 205
Macomb, MI 48044-5742
Phone (586) 226-6250

Other identifiers 3

IdentifierTypeStateIssuer
3383980MedicaidMI
4172282MedicaidMI
0E011720OtherMIBCBS GROUP NUMBER

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301064234MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Macomb Oakland Hospital Past Accepting new patients
Henry Ford Cornerstone Medical Group Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: smirza1141761@direct.hfhs.org
  • Direct secure messaging: shakeela.mirza.2@8209.direct.athenahealth.com
  • FHIR API: https://fhir-myrecord.cerner.com/r4/mQjCqHb5rkr1u1foU4dqhQPBpi7Qk9R4/

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298937600000",
    "number": "1902856578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46591 ROMEO PLANK RD",
            "address_2": "SUITE 205",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480445742",
            "telephone_number": "586-226-6250",
            "fax_number": "586-226-6255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46591 ROMEO PLANK RD",
            "address_2": "SUITE 205",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480445742",
            "telephone_number": "586-226-6250",
            "fax_number": "586-226-6255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "SHAKEELA",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2011-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301064234",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MI",
            "license": "4301064234",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3383980",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4172282",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "0E011720",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macomb, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; 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.