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NPI Code Detail

MEDICARE: DR. MATTHEW MIRIANI D.O.

MEDICARE: DR. MATTHEW MIRIANI D.O.
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
1207Q00000XFamily Medicine PhysicianR7H77MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00033622OTHERMORAILROAD MEDICARE

General Provider Information

NPI Number : 1619940277
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW MIRIANI D.O.
Provider Business Mailing Address
First Line : PO BOX 955534
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-5534
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2024 DORSETT VLG
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-2208
Country : US
Telephone Number : 314-590-0550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 10/23/2020

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