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General NPI Number Information
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NPI Number | 1972529444
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Entity Type | Individual
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Provider Name | DALMACIO L MIRANDA JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 8413 LAKE AVE
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City | CLEVELAND
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State | OH
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Zip | 44102-1909
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Country | US
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Telephone | 216-281-5300
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Fax | 216-281-0371
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Provider Business Mailing Address
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Address Line | 8413 LAKE AVE
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City | CLEVELAND
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State | OH
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Zip | 44102-1909
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Country | US
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Telephone | 216-281-5300
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Fax | 216-281-0371
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 35045229
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License Number State | OH
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