Provider Demographics
NPI:1508881293
Name:MIGLIAZZO, ANTHONY G (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:MIGLIAZZO
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 1:4911 S ARROWHEAD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7005
Mailing Address - Country:US
Mailing Address - Phone:816-478-8113
Mailing Address - Fax:816-478-8108
Practice Address - Street 1:4911 S ARROWHEAD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7005
Practice Address - Country:US
Practice Address - Phone:816-478-8113
Practice Address - Fax:816-478-8108
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3D48207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
10399093OtherBCBS
MO201897758Medicaid
B376232BMedicare ID - Type Unspecified
10399093OtherBCBS