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NPI Code Detail

MEDICARE: DR. CARLOS DANIEL MIRANDA III M.D.

MEDICARE: DR. CARLOS DANIEL MIRANDA III M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician14198ND
22080P0202XPediatric Cardiology Physician14198ND

General Provider Information

NPI Number : 1235446865
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARLOS DANIEL MIRANDA III M.D.
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-328-6585
Fax Number :
Provider Business Practice Location Address
First Line : 801 BROADWAY N
Second Line :
City : FARGO
State : ND
Zip : 58102-3641
Country : US
Telephone Number : 701-234-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2010
Last Update Date : 06/10/2026

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