Healthcare Provider Details

I. General information

NPI: 1043233414
Provider Name (Legal Business Name): KAREN K MIURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 RITTENHOUSE SQ SUITE 1801
PHILADELPHIA PA
19103-5837
US

IV. Provider business mailing address

1810 S. RITTENHOUSE SQUARE SUITE 1801
PHILADELPHIA PA
19103-5827
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-1716
  • Fax: 215-731-1466
Mailing address:
  • Phone: 215-735-1716
  • Fax: 215-731-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD014479E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: