Provider Demographics
NPI:1437471927
Name:MARK R MIGLIORI, MD, PA
Entity Type:Organization
Organization Name:MARK R MIGLIORI, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIGLIORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-925-1111
Mailing Address - Street 1:7450 FRANCE AVE S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4787
Mailing Address - Country:US
Mailing Address - Phone:952-925-1111
Mailing Address - Fax:
Practice Address - Street 1:7450 FRANCE AVE S
Practice Address - Street 2:SUITE 220
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4787
Practice Address - Country:US
Practice Address - Phone:952-925-1111
Practice Address - Fax:952-922-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35467261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center