M A MIRZA, LLC (NPI# 1376757617) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376757617 |
| Entity Type | Organization |
| Organization Name | M A MIRZA, LLC |
| Other Organization Name | WHITE OAK PSYCHIATRIC SERVICES |
| Practice Address |
4045 Ne Lakewood Way Suite 130 Lees Summit MO 64064-1799 |
| Practice Telephone | 8168862184 |
| Practice Fax Number | 8168862397 |
| Mailing Telephone | 8168862184 |
| Mailing Fax Number | 8168862397 |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2014-03-21 |
| NPI Deactivation Date | 08/14/2008 |
| NPI Reactivation Date | 2013-05-14 |
| Authorized Official Name | DR. MOHAMMED AZHER MIRZA (OWNER) |
| Authorized Official Telephone | 8162285335 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TP0016X |
Psychologist Specialization: Prescribing (Medical) |
RICIO | MO | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| WHITE OAK PSYCHIATRIC SERVICES | Doing Business As Name - Organization |
| Street Address |
4045 NE LAKEWOOD WAY SUITE 130 |
| City | LEES SUMMIT |
| State | MO |
| Zip Code | 64064-1799 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396723706 | Casey S Prough | Psychiatry & Neurology | 4045 Ne Lakewood Way, Suite 130, Lees Summit, MO 64064-1799 | 2006-01-05 |
| 1336355585 | Shubha Raja | Psychiatry & Neurology | 4045 Ne Lakewood Way, Suite 130, Lees Summit, MO 64064-1799 | 2007-05-15 |
| 1710067822 | Mohammed Azher Mirza | Psychiatry & Neurology | 4045 Ne Lakewood Way, Ste 130, Lees Summit, MO 64064-1995 | 2006-10-16 |
| 1134235112 | Bruce Eugene Rosenbaum | Dentist | 4045 Ne Lakewood Way, Suite 150, Lees Summit, MO 64064-1703 | 2006-08-22 |
| 1871525162 | Marguerite Devonne French | Psychiatry & Neurology | 4045 Ne Lakewood Way, Suite 130, Lees Summit, MO 64064-1799 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225647704 | James Andrew Kleoppel | Dentist | 3320 Ne Ralph Powell Rd., Lee's Summit, MO 64064 | 2020-07-30 |
| 1255991238 | Lee Summit Asc Kc LLC | Clinic/Center | 2861 Ne Independence Avenue, Suite 101, Lee's Summitt, MO 64064 | 2019-06-20 |
| 1073014676 | Sonya Renee Aversman | Dietitian, Registered | 3680 Ne Akin Dr, Suite 134, Lee's Summit, MO 64064 | 2018-02-28 |
| 1407398365 | Lakewood Chiropractic, P.C. | Chiropractor | 731 Ne Lakewood Boulevard, Lee's Summit, MO 64064 | 2016-11-09 |
| 1417403015 | Mikaela Groff | Dietitian, Registered | 401 Ne Grant Ct, Lee's Summit, MO 64064 | 2016-09-01 |
| 1952756405 | Sarah C. Vignery | Speech-Language Pathologist | 3600 Ne Ralph Powell Rd. Suite E, Lee's Summit, MO 64064 | 2016-05-03 |
| 1790146058 | Aneliya H Hristova | Physician Assistant | 3601 Ne Ralph Powell Road., Lee's Summit, MO 64064 | 2016-03-15 |
| 1821469982 | Alysse Barrett Doane | Nurse Practitioner | 2714 Ne Mcbaine Drive, Lees Summit, MO 64064 | 2015-10-15 |
| 1346638814 | Donna Thomas Dds, PC | Dentist | 3359 Ne Ralph Powell Rd, Lee's Summit, MO 64064 | 2015-01-06 |
| 1437579208 | Gregory Lohr | Dentist | 2931 Ne Independence Ave, Lees Summit, MO 64064 | 2014-04-21 |
| Find all providers in zip 64064 | ||||
| Taxonomy Code | 103TP0016X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Prescribing (Medical) |
| Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |
| Notes: Source: Louisiana Academy of Medical Psychologists Note: Some states issue licenses under Medical Psychologist. [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114253549 | Lynn Ashley Cunningham | Psychologist | 8 W Pine Ct, Saint Louis, MO 63108-2110 | 2009-10-20 |
| 1972167773 | Great Plains Hospital | Psychologist | 1500 W Ashland St, Nevada, MO 64772-1710 | 2019-04-26 |
| 1902244825 | Gateway Psychiatric Group, LLC | Psychologist | 11710 Old Ballas Rd, Suite 110, Creve Coeur, MO 63141-7076 | 2013-06-13 |
| 1972859510 | Forest Park Neurology LLC | Psychologist | 5811 E Truman Rd, Kansas City, MO 64126-2400 | 2012-08-01 |
| 1386767994 | Phoenix Psychological Group, Inc | Psychologist | 225 S Meramec Ave, Suite 506, Saint Louis, MO 63105-3596 | 2007-04-09 |
| City | LEES SUMMIT |
| Zip Code | 64064 |
Please comment or provide details below to improve the information on M A MIRZA, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.