Provider Demographics
NPI:1043667611
Name:HIRANO, MIKI
Entity Type:Individual
Prefix:
First Name:MIKI
Middle Name:
Last Name:HIRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 GREENS DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4612
Mailing Address - Country:US
Mailing Address - Phone:919-781-1437
Mailing Address - Fax:
Practice Address - Street 1:250 E SUPERIOR ST STE 4-2304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-926-5522
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250685602085R0202X
VA01012787102085R0202X
NC2023-010182085R0202X
SCMD900202085R0202X
IL0361575312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology