Provider Demographics
NPI:1790703809
Name:MIRANDA, DALTON JUNQUEIRA DE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DALTON
Middle Name:JUNQUEIRA DE
Last Name:MIRANDA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:416 CONNABLE AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2212
Mailing Address - Country:US
Mailing Address - Phone:231-487-5868
Mailing Address - Fax:231-487-9803
Practice Address - Street 1:416 CONNABLE AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2212
Practice Address - Country:US
Practice Address - Phone:231-487-5868
Practice Address - Fax:231-487-9803
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-01-21
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Provider Licenses
StateLicense IDTaxonomies
MI4301088656207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease