Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 35.120783 | OH |
N | 207RI0200X | Infectious Disease | 35120783 | OH |
NPI | 1073775318 |
---|---|
Provider Name | Jill Elizabeth Miracle |
First Address | Cleveland, OH 44109-1900 |
Second Address | Cleveland, OH 44109-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 27/12/2021 |