Provider Demographics
NPI:1083667265
Name:MIRECKI, FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:MIRECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 OTROBANDO AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2116
Mailing Address - Country:US
Mailing Address - Phone:860-886-0023
Mailing Address - Fax:860-886-0024
Practice Address - Street 1:164 OTROBANDO AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2116
Practice Address - Country:US
Practice Address - Phone:860-886-0023
Practice Address - Fax:860-886-0024
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT33689207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
010033689CT05OtherANTHEM/ECCD:06-1616101
033689OtherCONNECTICARE
001336892OtherBLUECARE FAMILY PLAN
110088356OtherRR MED/ECCG: 06-1049086
030514OtherHEALTHNET/ECCG:06-1049086
0V9737OtherHEALTHNET/ECCD:06-1616101
NLS105OtherOXFORD/ECCG: 06-1049086
CT001336892Medicaid
010033689CT01OtherANTHEM/ECCG:06-1049086
060064827OtherRR MED/ECCD: 06-1616101
500HBC444CT01OtherANTHEM/HOSP-BASED ECCD
P2524312OtherOXFORD/ECCD: 06-1616101
110088356OtherRR MED/ECCG: 06-1049086
033689OtherCONNECTICARE
F78799Medicare UPIN