Provider Demographics
NPI:1588608855
Name:MIRABILE, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MIRABILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4550 W 109TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1360
Mailing Address - Country:US
Mailing Address - Phone:913-541-9495
Mailing Address - Fax:913-541-1264
Practice Address - Street 1:4550 W 109TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1360
Practice Address - Country:US
Practice Address - Phone:913-541-9495
Practice Address - Fax:913-541-1264
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS423989207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100133630BMedicaid
MO203560511Medicaid
MO203560511Medicaid
KSF27638Medicare UPIN