Provider Demographics
NPI:1376673244
Name:MIRANDA, LEONIDAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONIDAS
Middle Name:S
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 1:800 PEAKWOOD DR STE 5D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2903
Mailing Address - Country:US
Mailing Address - Phone:832-353-2500
Mailing Address - Fax:281-880-9483
Practice Address - Street 1:800 PEAKWOOD DR STE 5D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2903
Practice Address - Country:US
Practice Address - Phone:832-353-2500
Practice Address - Fax:281-880-9483
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFTL 41417208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167310503Medicaid
TX167310502Medicaid
TX8A9394OtherBCBS
TXP00770738OtherRAILROAD MEDICARE
TX167310501Medicaid
TX8A9394OtherBCBS
TX8L21640Medicare PIN
TX167310501Medicaid
TXP00770738OtherRAILROAD MEDICARE