MEDICARE: DR. PHILIP C. MIRMELLI MD

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	207K00000X	Allergy & Immunology Physician	ME25815	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78527Y	OTHER	FL	MEDICARE
3	78527N	OTHER	FL	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1982667705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP C. MIRMELLI MD

Provider Business Mailing Address
First Line	:	11880 SW 40TH ST
Second Line	:	SUITE 304
City	:	MIAMI
State	:	FL
Zip	:	33175-3584
Country	:	US
Telephone Number	:	305-223-8808
Fax Number	:	305-223-8974

Provider Business Practice Location Address
First Line	:	400 ARTHUR GODFREY RD
Second Line	:	SUITE 504
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3516
Country	:	US
Telephone Number	:	305-538-8339
Fax Number	:	305-538-4907

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	09/21/2015

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Directions to “ DR. PHILIP C. MIRMELLI MD” Practice Location

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