Michael J. Mirro MD
Cardiovascular Disease Physician in Fort Wayne, IN(View on Map)
Full Name
Michael J Mirro MD
NPI Number
1053303222
NPI Type
Individual Provider
Gender
Male
Enumeration Date
08/15/2005
Specialties
(Taxonomies)Name
Code
207RC0000X
207RC0001X
207RG0300X
Primary Taxonomy
Yes
No
No
Licenses
State
Indiana
License Number
01025414A
Contact
Information
Purpose
Mailing
Location
Address
3926 NEW VISION DR
11108 PARKVIEW CIRCLE DR
City
Fort Wayne
Fort Wayne
State
IN
IN
Postal Code
46845-1712
46845-1730
Country
US
US
Telephone Number
(260) 266-8213
(260) 266-5700
Identifiers
Identifier
100138540
000000641091
060070554
0509079
P00782366
Identifier State
IN
IN
IN
OH
IN
Identifier Issuer
Unknown
ANTHEM
RR MEDICARE
Unknown
R.R. MEDICARE
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 04/21/2017
Provider Address
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