Provider Demographics
NPI:1831185800
Name:MIRICH, ERNEST C (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:C
Last Name:MIRICH
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 1:8550 BROADWAY
Mailing Address - Street 2:STE C
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7193
Mailing Address - Country:US
Mailing Address - Phone:219-769-3550
Mailing Address - Fax:219-769-8604
Practice Address - Street 1:8550 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7032
Practice Address - Country:US
Practice Address - Phone:219-769-3550
Practice Address - Fax:219-769-8604
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01018811207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083040OtherANTHEM
IN192820HOtherMEDICARE PART B
IN100377790Medicaid
IN110085078OtherRAILROAD MEDICARE
IN385970AOtherMEDICARE PART B
IN2210201OtherMEDICARE
INB28972Medicare UPIN
IN192820HOtherMEDICARE PART B