Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 63558 | MN |
NPI | 1376807461 |
---|---|
Provider Name | David Miranda |
First Address | Saint Cloud, MN 56303-2736 |
Second Address | Saint Cloud, MN 56303-2736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2012 |
Last Update Date | 12/07/2019 |