Provider Demographics
NPI:1124549233
Name:MIRANDA, ANDRE FILIPE (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE FILIPE
Middle Name:
Last Name:MIRANDA
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 1:1555 DOCTORS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4132
Mailing Address - Country:US
Mailing Address - Phone:706-242-5201
Mailing Address - Fax:706-242-5204
Practice Address - Street 1:1555 DOCTORS DR STE 101
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4132
Practice Address - Country:US
Practice Address - Phone:706-242-5201
Practice Address - Fax:706-242-5204
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA90432208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program