MEDICARE: MARIA ANTONIO-MIRANDA 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
1	207RP1001X	Pulmonary Disease Physician	ME74317	FL

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	:	1972525327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ANTONIO-MIRANDA M.D.

Provider Business Mailing Address
First Line	:	1665 KINGSLEY AVE STE 107
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4415
Country	:	US
Telephone Number	:	904-269-9200
Fax Number	:	904-269-7796

Provider Business Practice Location Address
First Line	:	1665 KINGSLEY AVE STE 107
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4415
Country	:	US
Telephone Number	:	904-269-9200
Fax Number	:	904-269-7796

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/25/2024

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Directions to “ MARIA ANTONIO-MIRANDA M.D.” Practice Location

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