DR. MICHAEL AV MIRZAI (NPI# 1508909540) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508909540 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL AV MIRZAI |
| Credential | MD |
| Practice Address |
1800 E Interstate Ave Ste B Bismarck ND 58503-1566 |
| Mailing Address |
Po Box 5074 Sioux Falls SD 57117-5074 |
| Practice Telephone | 7013236543 |
| Practice Fax Number | 7013235492 |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-08-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
12502 | ND | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
K-6777 | TX | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
12616 | HI | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
12502 | ND | Allopathic & Osteopathic Physicians |
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
12616 | HI | Allopathic & Osteopathic Physicians |
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
K-6777 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 1452924 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 900 E Broadway Ave, Chi/st. Alexius Medical Center, Bismarck, ND 585014520 | 7015307353 | 7015307319 |
| Street Address |
1800 E INTERSTATE AVE STE B |
| City | BISMARCK |
| State | ND |
| Zip Code | 58503-1566 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174586697 | Richard E Arndorfer | Psychologist | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2006-04-07 |
| 1861864415 | Stephanie Macdonald | Nurse Practitioner | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2015-10-22 |
| 1710372362 | Annah Preszler | Psychiatry & Neurology | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2015-03-31 |
| 1124467741 | Adam Jangula | Psychiatry & Neurology | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2013-06-17 |
| 1003149790 | Nicole L Cross-hillman | Psychologist | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2009-09-11 |
| 1417187907 | Prem Nath Pathak | Psychiatry & Neurology | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2009-07-20 |
| 1457580110 | Sara R Bashus | Social Worker | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2009-07-02 |
| 1689829202 | Christen G Herrick | Psychologist | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2008-11-24 |
| 1700074341 | Lori Jill Charbonneau | Social Worker | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2007-10-09 |
| 1053493494 | Darla J Stafford | Social Worker | 1800 E Interstate Ave Ste B, Bismarck, ND 58503-1566 | 2006-10-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356951503 | Community Options for Residential and Employment Services, Inc | Community/Behavioral Health | 4909 Shelburne St, Bismarck, ND 58503 | 2020-08-03 |
| 1104460476 | Brittany Lee Feil | Registered Nurse | 808 N Washington St., Bismarck, ND 58503 | 2019-10-30 |
| 1760030670 | Rachel Lees | Technician | 1727 Valley Drive, Bismark, ND 58503 | 2019-09-04 |
| 1700444619 | St Alexius Medical Center | Non-Pharmacy Dispensing Site | 807 East Main Suite A, Bismarck, ND 58503 | 2019-06-05 |
| 1881162972 | White Drug Co of Jamestown Inc | Pharmacy | 900 Ne 43rd Ave, Bismarck, ND 58503 | 2018-11-06 |
| 1104347137 | Adapt, Inc. | Counselor | 1720 Burnt Boat Drive, Suite 108, Bismarck, ND 58503 | 2017-06-29 |
| 1679010953 | Optimum Therapies of North Dakota, Inc | Physical Therapist | 4204 Boulder Ridge Rd, Suite 100, Bismarck, ND 58503 | 2017-01-25 |
| 1972954162 | Ava Burckhard | Speech-Language Pathologist | 4501 Coleman St N Suite #103, Pediatric Therapy Partners, Bismarck, ND 58503 | 2016-06-29 |
| 1306292842 | Margaret Williams | Nurse Practitioner | 4315 Ottawa St, Bismarck, ND 58503 | 2016-05-13 |
| 1649638958 | Horizon Chiropractic & Wellness PC | Chiropractor | 4535 Northern Sky Dr., Bismarck, ND 58503 | 2016-02-01 |
| Find all providers in zip 58503 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124064431 | Laura B Schield | Psychiatry & Neurology | 2787 97th Ave Nw, Bismarck, ND 58503-8452 | 2006-06-22 |
| 1245541895 | Stephanie Jallen | Psychiatry & Neurology | 900 E Broadway Ave, Bismarck, ND 58501-4520 | 2010-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376958397 | Kenneth Chidi Asogwa | Psychiatry & Neurology | 860 S Columbia Rd, Grand Forks, ND 58201 | 2014-06-28 |
| 1619297785 | Jacqueline M Bell | Psychiatry & Neurology | 1900-8th Ave. S.e., Minot, ND 58701-4935 | 2010-06-10 |
| 1346479185 | Nivedita Sudhir Nadkarni | Psychiatry & Neurology | 1702 University Drive South, Fargo, ND 58103 | 2009-07-14 |
| 1003952144 | Kondal Madaram | Psychiatry & Neurology | 1000 S Columbia Rd, Grand Forks, ND 58201-4032 | 2007-01-29 |
| 1538218391 | Jane Charlotte Gaffrey | Psychiatry & Neurology | 100 4th St S, Fargo, ND 58103-1929 | 2007-01-10 |
| 1326119884 | Deidre L Richards | Psychiatry & Neurology | 1900 8th Ave Se, Minot, ND 58701-4935 | 2006-11-13 |
| 1306867528 | Jeanine L Roembach | Psychiatry & Neurology | 100 4th St S, Fargo, ND 58103-1929 | 2006-07-22 |
| 1982622528 | Kenneth J Fischer | Psychiatry & Neurology | 100 4th St S, Fargo, ND 58103-1929 | 2006-07-18 |
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| 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.