Provider Demographics
NPI:1598807778
Name:MIRAKIAN, ALEX SARMEN
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:SARMEN
Last Name:MIRAKIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PGA BLVD APT 439
Mailing Address - Street 2:
Mailing Address - City:N PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2788
Mailing Address - Country:US
Mailing Address - Phone:813-777-4314
Mailing Address - Fax:
Practice Address - Street 1:8980 S US HIGHWAY 1 STE 105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3482
Practice Address - Country:US
Practice Address - Phone:772-281-3060
Practice Address - Fax:772-281-3055
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1583122085R0001X
AL416382085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP938828OtherOPTIMUM
AL258638Medicaid
FL9811089OtherAETNA
AL256925Medicaid
FL14301OtherDIMENSION HEALTH PPO
FL329725OtherAVMED
ALA98751AOtherMEDICARE PTAN
ALP02566934OtherRAILROAD MEDICARE
FLP997944OtherFREEDOM
FL58061OtherBCBS
FLP01568224OtherRR MEDICARE