MEDICARE: DR. JOSEPH MIRRO JR. MD

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
1	2080P0207X	Pediatric Hematology & Oncology Physician	13553	TN
2	2080P0207X	Pediatric Hematology & Oncology Physician	4301100173	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1447261730	OTHER	MI	BCBS - WMCC
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427051200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MIRRO JR. MD

Provider Business Mailing Address
First Line	:	200 N PARK ST
Second Line	:	WEST MICHIGAN CANCER CENTER
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-3731
Country	:	US
Telephone Number	:	269-910-6555
Fax Number	:	269-384-8610

Provider Business Practice Location Address
First Line	:	200 N PARK ST
Second Line	:	WEST MICHIGAN CANCER CENTER
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-3731
Country	:	US
Telephone Number	:	269-910-6555
Fax Number	:	269-384-8610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/19/2014

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MEDICARE: DR. JOSEPH MIRRO JR. MD

Scope of Practice

Other Identifiers

General Provider Information

Similar Medicare Providers

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