Healthcare Provider Details

I. General information

NPI: 1841499472
Provider Name (Legal Business Name): NEIL MIRANSKY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 73RD ST 1 NORTH TOWER
SOUTH MIAMI FL
33143-4679
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 786-595-0164
  • Fax: 786-533-9512
Mailing address:
  • Phone: 786-595-0164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS 9791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: