Provider Demographics
NPI:1447339643
Name:WILLIAM S MIRANDO MD LLC
Entity type:Organization
Organization Name:WILLIAM S MIRANDO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SKIPPON
Authorized Official - Last Name:MIRANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-985-3376
Mailing Address - Street 1:201 N LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1124
Mailing Address - Country:US
Mailing Address - Phone:440-985-3376
Mailing Address - Fax:440-985-3379
Practice Address - Street 1:201 N LEAVITT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1124
Practice Address - Country:US
Practice Address - Phone:440-985-3376
Practice Address - Fax:440-985-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060349M207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0300383OtherUHC
OH293642175022OtherMEDICAL MUTUAL
OH000000197517OtherANTHEM
OH39084OtherCARESOURCE
OH0892780Medicaid
OH4337165OtherAETNA
OH4337165OtherAETNA
OH0892780Medicaid