Provider Demographics
NPI:1790765873
Name:MIRANI, MAHENDRA JAMNADAS (MD)
Entity Type:Individual
Prefix:
First Name:MAHENDRA
Middle Name:JAMNADAS
Last Name:MIRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4824
Mailing Address - Country:US
Mailing Address - Phone:716-648-3250
Mailing Address - Fax:716-649-5816
Practice Address - Street 1:152 LAKE ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4824
Practice Address - Country:US
Practice Address - Phone:716-648-3250
Practice Address - Fax:716-649-5816
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113620-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0400894OtherINDEPENDANT HEATH ASSOC.
NY218742OtherWORKMAN'S COMPENSATION
NY00010119901OtherUNIVERA
NY87H62Medicaid
NY00010119901OtherUNIVERA
NYB35958Medicare UPIN