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NPI Code Detail

MEDICARE: ANETRA SHARICE MIRANDA DPM

MEDICARE: ANETRA SHARICE MIRANDA DPM
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
1213ES0103XFoot & Ankle Surgery Podiatrist2125TX
2213ES0103XFoot & Ankle Surgery Podiatrist80195MS

General Provider Information

NPI Number : 1871770917
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANETRA SHARICE MIRANDA DPM
Provider Business Mailing Address
First Line : 6445 FM 1463 RD STE 160-213
Second Line :
City : KATY
State : TX
Zip : 77494-4027
Country : US
Telephone Number : 866-925-5662
Fax Number : 866-925-5662
Provider Business Practice Location Address
First Line : 5373 W ALABAMA ST STE 204
Second Line :
City : HOUSTON
State : TX
Zip : 77056-5923
Country : US
Telephone Number : 866-925-5662
Fax Number : 866-925-5662
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2008
Last Update Date : 09/22/2021

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Directions to “ ANETRA SHARICE MIRANDA DPM” Practice Location

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