| Doctor Name: | SANJIDA MIRZA |
| NPI Number: | 1174564199 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 036066426 |
| Business Practice Address: | 337 E 35th St Chicago, IL - 60616 |
| Business Phone Number: | 3128423547 |
| Business Fax Number: | 3128421878 |
| Mailing Address: | 849 Oak Wood Dr, WEST MONT |
| State: | IL |
| Postal Code: | 60559 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/09/2006 |
| NPI Last Update Date: | 12/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 036066426 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |