Provider Demographics
NPI:1164483178
Name:MIRO-QUESADA, MIGUEL V (M D)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:V
Last Name:MIRO-QUESADA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-800-0656
Mailing Address - Fax:713-827-1380
Practice Address - Street 1:925 GESSNER RD
Practice Address - Street 2:SUITE 600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2545
Practice Address - Country:US
Practice Address - Phone:713-827-9525
Practice Address - Fax:713-468-3561
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7282207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136716103Medicaid
2224930OtherBLUE LINK
25498OtherAMERIGROUP
10014650OtherAMERICAID
85272NOtherBLUECHOICE
4087245OtherAETNA
10014649OtherAMERICAID
TX830005872OtherRAILROAD MEDICARE
TX136716102Medicaid
TX136716102Medicaid
TX830005872OtherRAILROAD MEDICARE
4087245OtherAETNA