Healthcare Provider Details

I. General information

NPI: 1023095460
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER MISKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BURKARTH RD EMERGENCY DEPARTMENT
WARRENSBURG MO
64093-3101
US

IV. Provider business mailing address

403 BURKARTH RD
WARRENSBURG MO
64093-3101
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-8824
  • Fax: 660-747-7166
Mailing address:
  • Phone: 660-747-2500
  • Fax: 660-747-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR3G00
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: