MEDICARE: MI CLINICS OF AMERICA

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	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1790301679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI CLINICS OF AMERICA

Provider Business Mailing Address
First Line	:	2950 GLENDALE MILFORD RD STE 520
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-3131
Country	:	US
Telephone Number	:	513-275-5275
Fax Number	:	513-906-5275

Provider Business Practice Location Address
First Line	:	2950 GLENDALE MILFORD RD STE 520
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-3131
Country	:	US
Telephone Number	:	513-275-5275
Fax Number	:	513-906-5275

Authorized Official
Title or Position	:	PRACTICE MANAGER/CPA
Name	:	MITA MORAR
Credential	:	CPA
Telephone Number	:	513-275-5275

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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Directions to “MI CLINICS OF AMERICA ” Practice Location

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