MEDICARE: KATHERINE K. MIURA, MD, LLC

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	2084P0800X	Psychiatry Physician	81163	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1801853007	OTHER	MA	NPI TYPE 1
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457642894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHERINE K. MIURA, MD, LLC

Provider Business Mailing Address
First Line	:	564 LORING AVE
Second Line	:	UNIT 2
City	:	SALEM
State	:	MA
Zip	:	01970-4276
Country	:	US
Telephone Number	:	978-594-1662
Fax Number	:	978-336-5887

Provider Business Practice Location Address
First Line	:	564 LORING AVE
Second Line	:	UNIT 2
City	:	SALEM
State	:	MA
Zip	:	01970-4276
Country	:	US
Telephone Number	:	978-594-1662
Fax Number	:	978-336-5887

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATHERINE KIMI MIURA
Credential	:	M.D.
Telephone Number	:	978-594-1662

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	04/19/2011

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