Provider Demographics
NPI:1942228168
Name:MIGLIORI, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:MIGLIORI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7450 FRANCE AVE S STE 220
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4792
Mailing Address - Country:US
Mailing Address - Phone:952-925-1111
Mailing Address - Fax:952-922-3446
Practice Address - Street 1:7450 FRANCE AVE S STE 220
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4792
Practice Address - Country:US
Practice Address - Phone:952-925-1111
Practice Address - Fax:952-942-3446
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN35467261Q00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN097217700Medicaid
MN097217700Medicaid