Provider Demographics
NPI:1629269493
Name:WILLIAM S MIRANDO MD LLC
Entity Type:Organization
Organization Name:WILLIAM S MIRANDO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SKIPPON
Authorized Official - Last Name:MIRANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-998-3376
Mailing Address - Street 1:2885 N RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4134
Mailing Address - Country:US
Mailing Address - Phone:440-998-3376
Mailing Address - Fax:440-997-5751
Practice Address - Street 1:2885 N RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4134
Practice Address - Country:US
Practice Address - Phone:440-998-3376
Practice Address - Fax:440-997-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-060349M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0892780Medicaid
OHF37607Medicare UPIN
OH0892780Medicaid