Healthcare Provider Details

I. General information

NPI: 1205930419
Provider Name (Legal Business Name): JAMES MIRABILE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 W 109TH ST SUITE 130
OVERLAND PARK KS
66211-1360
US

IV. Provider business mailing address

4550 W 109TH ST SUITE 130
OVERLAND PARK KS
66211-1360
US

V. Phone/Fax

Practice location:
  • Phone: 913-888-7546
  • Fax: 913-338-1337
Mailing address:
  • Phone: 913-888-7546
  • Fax: 913-338-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL D MCANALLY
Title or Position: RN
Credential:
Phone: 913-541-5231