MEDICARE: MELANIE ETHELL MIRANDE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35072373	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437123783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE ETHELL MIRANDE MD

Provider Business Mailing Address
First Line	:	6525 MARKET AVE N
Second Line	:	SUITE 101
City	:	CANTON
State	:	OH
Zip	:	44721-2430
Country	:	US
Telephone Number	:	330-494-9785
Fax Number	:	330-494-9798

Provider Business Practice Location Address
First Line	:	6525 MARKET AVE N
Second Line	:	SUITE 101
City	:	CANTON
State	:	OH
Zip	:	44721-2430
Country	:	US
Telephone Number	:	330-494-9785
Fax Number	:	330-494-9798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/04/2024

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Directions to “ MELANIE ETHELL MIRANDE MD” Practice Location

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