MEDICARE: WILLIAM S. MIRANDO, MD,LLC

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	174400000X	Specialist	35-060349M	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	:	1700077575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM S. MIRANDO, MD,LLC

Provider Business Mailing Address
First Line	:	2885 N RIDGE RD E
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-4134
Country	:	US
Telephone Number	:	440-998-3376
Fax Number	:	440-997-5751

Provider Business Practice Location Address
First Line	:	201 N LEAVITT RD
Second Line	:
City	:	AMHERST
State	:	OH
Zip	:	44001-1124
Country	:	US
Telephone Number	:	440-985-3376
Fax Number	:	440-985-3379

Authorized Official
Title or Position	:	MEDICAL DOCTOR/OWNER
Name	:	DR. WILLIAM SKIPPON MIRANDO
Credential	:	M.D.
Telephone Number	:	440-998-3376

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	10/23/2014

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