Provider Demographics
NPI:1518133792
Name:MIRAKA, ALTIN (DO)
Entity Type:Individual
Prefix:
First Name:ALTIN
Middle Name:
Last Name:MIRAKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31125 PORTSIDE DR
Mailing Address - Street 2:APT# 6206
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-4245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 HURLEY PLZ
Practice Address - Street 2:SUITE 109
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5903
Practice Address - Country:US
Practice Address - Phone:810-262-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019268208800000X
IN02005220A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology