Provider Demographics
NPI:1073714408
Name:MIRAU, MICHELLE C (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:MIRAU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:610 30TH AVENUE WEST
Mailing Address - Street 2:ALEXANDRIA CLINIC PA
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-763-5123
Mailing Address - Fax:320-763-7883
Practice Address - Street 1:610 30TH AVENUE WEST
Practice Address - Street 2:ALEXANDRIA CLINIC PA
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-763-5123
Practice Address - Fax:320-763-7883
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN49573207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN49573OtherLICENSE