MARIO MIRANDA

PEORIA, IL
NPI1376505420
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207P00000X Emergency Medicine
(Licence: IL  036096715)
Additional Taxonomies207Q00000X Family Medicine
(Licence: IL  036096715)
Enumeration Date2006-04-04
Last Update Date2008-02-05
Business Address
-- MARIO MIRANDA DO
221 NE GLEN OAK AVE
PEORIA, IL 61603-4307
Phone number: 309-672-5522
Mailing Address
-- MARIO MIRANDA DO
21276 NETWORK PL
CHICAGO, IL 60673-1212
Phone number: 877-485-4474