Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 14198 | ND |
NPI | 1235446865 |
---|---|
Provider Name | Dr. Carlos Daniel Miranda III |
First Address | Fargo, ND 58122-2484 |
Second Address | Fargo, ND 58102-3641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2010 |
Last Update Date | 17/09/2019 |