Provider Demographics
NPI:1053766089
Name:ACUTE CARE PHYSICIANS OF PHILADELPHIA LLC
Entity type:Organization
Organization Name:ACUTE CARE PHYSICIANS OF PHILADELPHIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-381-9598
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-0069
Mailing Address - Country:US
Mailing Address - Phone:856-381-9598
Mailing Address - Fax:
Practice Address - Street 1:1930 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2328
Practice Address - Country:US
Practice Address - Phone:856-381-9598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431989207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty