Healthcare Provider Details

I. General information

NPI: 1528324910
Provider Name (Legal Business Name): MIGUEL ANGEL SOTO MIRANDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MADISON AVE STE 315
MEMPHIS TN
38103-3454
US

IV. Provider business mailing address

910 MADISON AVE STE 315
MEMPHIS TN
38103-3454
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-1350
  • Fax: 901-448-7306
Mailing address:
  • Phone: 901-448-1350
  • Fax: 901-448-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: