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NPI Code Detail

MEDICARE: DR. JOSEPH N MIRKOVICH JR. M.D.

MEDICARE: DR. JOSEPH N MIRKOVICH JR. 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
12084P0800XPsychiatry Physician39185TN
22084P0800XPsychiatry PhysicianA77930CA
32084P0800XPsychiatry Physician77930CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891761623
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH N MIRKOVICH JR. M.D.
Provider Business Mailing Address
First Line : 6521 VIA LORENZO
Second Line :
City : RANCHO PALOS VERDES
State : CA
Zip : 90275-6543
Country : US
Telephone Number : 323-842-2658
Fax Number : 888-235-1709
Provider Business Practice Location Address
First Line : 7500 HELLMAN AVE
Second Line :
City : ROSEMEAD
State : CA
Zip : 91770-2216
Country : US
Telephone Number : 626-288-1160
Fax Number : 626-371-1320
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2006
Last Update Date : 06/21/2019

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