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General NPI Number Information
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NPI Number | 1609737048
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Entity Type | Organization
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Legal Business Name | MIRROR HEART LLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 2666 KINGS HWY
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City | LOUISVILLE
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State | KY
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Zip | 40205-2668
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Country | US
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Telephone | 947-436-7794
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Fax |
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Provider Business Mailing Address
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Address Line | 4634 NW 74TH AVE CR-615707
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City | MIAMI
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State | FL
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Zip | 33166-6576
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COMPANY OWNER
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Name | MR. ORIEL A. MCLEAN
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Credential | MD
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Telephone | 947-436-7794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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