MEDICARE: DR. DIDEM MIRALOGLU M.D., M.S.

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	207R00000X	Internal Medicine Physician	233008	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1942271218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIDEM MIRALOGLU M.D., M.S.

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE
Second Line	:	BOX 278980
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-637-7558
Fax Number	:	585-637-7566

Provider Business Practice Location Address
First Line	:	156 WEST AVE
Second Line	:	SUITE 106
City	:	BROCKPORT
State	:	NY
Zip	:	14420-1229
Country	:	US
Telephone Number	:	585-637-7558
Fax Number	:	585-637-7566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/24/2013

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