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NPI Code Detail

MEDICARE: DR. JUAN CAMILO MIRA M.D.

MEDICARE: DR. JUAN CAMILO MIRA 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
1208600000XSurgery Physician19092FL
2208600000XSurgery PhysicianMD-49649IA

General Provider Information

NPI Number : 1902245806
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN CAMILO MIRA M.D.
Provider Business Mailing Address
First Line : PO BOX 424
Second Line :
City : DES MOINES
State : IA
Zip : 50302-0424
Country : US
Telephone Number : 515-875-9255
Fax Number : 515-875-9223
Provider Business Practice Location Address
First Line : 1212 PLEASANT ST STE 211
Second Line :
City : DES MOINES
State : IA
Zip : 50309-1411
Country : US
Telephone Number : 515-875-9770
Fax Number : 515-875-9771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2013
Last Update Date : 12/26/2023

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