Miroshnichenko, Gennady G

Miroshnichenko, Gennady G is an individual health care provider with primary practice located at 1201 S Main St , Fort Worth TX 76104-4804. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Gynecologic Oncology. Allopathic & Osteopathic Physicians / Gynecologic Oncology is his primary health care specialty. Miroshnichenko, Gennady G can be contacted via phone (817) 702-6500.

Contact Information

Primary practice address
1201 S Main St Fort Worth TX 76104-4804
Phone: (817) 702-6500
Fax: (817) 702-6561
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X P4595 Texas
Allopathic & Osteopathic Physicians / Gynecologic Oncology 207VX0201X P4595 Texas

Profile Details

NPI number 1164784450
LBN Legal business name Miroshnichenko, Gennady G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2012
Last updated Feb 1st, 2021 - about 5 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 1164784450 NPPES
Texas MEDICAID 307460101
Texas Other 8DM684

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