Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA09265600 | NJ |
N | 111NI0900X | Internist | 25MA09265600 | NJ |
N | 207RC0200X | Critical Care Medicine | 15307 | NV |
N | 207RC0200X | Critical Care Medicine | 2016040161 | MO |
N | 207RC0200X | Critical Care Medicine | 4301106904 | MI |
Y | 207RC0200X | Critical Care Medicine | S0745 | TX |
N | 207RP1001X | Pulmonary Disease | 5720 | TN |
NPI | 1073787545 |
---|---|
Provider Name | Dr. Michael Mirzoyan |
First Address | Fort Worth, TX 76102-2375 |
Second Address | Corpus Christi, TX 78404-2235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 14/06/2021 |