Healthcare Provider Details

I. General information

NPI: 1215114889
Provider Name (Legal Business Name): KRISTA IRGENS MIGLIORE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2008
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 NW WASHINGTON BLVD SUITE A
HAMILTON OH
45013-6384
US

IV. Provider business mailing address

840 NW WASHINGTON BLVD STE A
HAMILTON OH
45013-6381
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-4165
  • Fax: 513-867-4168
Mailing address:
  • Phone: 513-867-5770
  • Fax: 513-737-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34010587
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number34010587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: