Miranda, Mario

Miranda, Mario is an individual health care provider with primary practice located at 221 Ne Glen Oak Ave , Peoria IL 61603-4307. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Miranda, Mario can be contacted via phone (309) 672-5522.

Contact Information

Primary practice address
221 Ne Glen Oak Ave Peoria IL 61603-4307
Phone: (309) 672-5522
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X Illinois
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X Illinois

Profile Details

NPI number 1376505420
LBN Legal business name Miranda, Mario
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 4th, 2006
Last updated Feb 5th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376505420 NPPES
Illinois Other P00196855 RAILROAD MEDICARE
Illinois Other 36096715 RAILROAD MEDICARE

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