Provider Demographics
NPI:1790781946
Name:MIRER, MIKHAIL (MD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:MIRER
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 1:500 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:1212 S ANDREWS AVE STE 201
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1828
Practice Address - Country:US
Practice Address - Phone:800-243-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1165372080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3099861OtherGHI
NY552992OtherBLUE CROSS BLUE SHIELD
NY01980092Medicaid
NY1911994OtherUNITEDHEALTHCARE
NY95941OtherVYTRA HEALTH PLANS
NY040426010759OtherFIDELIS
NY2C2066OtherHEALTHNET
NY7533054OtherAETNA/US HEALTHCARE
NYP1537630OtherOXFORD HEALTH PLANS
NY010206190NY01OtherANTHEM HEALTH
NY05-00433OtherUHC CHILD HEALTH PLUS
NY59065OtherMAGNACARE
NYAA50867OtherMDNY
NY01980092Medicaid