Basic Information
| Provider Information | |||||||||
| NPI: | 1790781946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIRER | ||||||||
| FirstName: | MIKHAIL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170332360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002431455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1212 S ANDREWS AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333161828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002433839 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0008X | ME116537 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 3099861 | 01 | NY | GHI | OTHER | 552992 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 01980092 | 05 | NY | MEDICAID | 1911994 | 01 | NY | UNITEDHEALTHCARE | OTHER | 95941 | 01 | NY | VYTRA HEALTH PLANS | OTHER | 040426010759 | 01 | NY | FIDELIS | OTHER | 2C2066 | 01 | NY | HEALTHNET | OTHER | 7533054 | 01 | NY | AETNA/US HEALTHCARE | OTHER | P1537630 | 01 | NY | OXFORD HEALTH PLANS | OTHER | 010206190NY01 | 01 | NY | ANTHEM HEALTH | OTHER | 05-00433 | 01 | NY | UHC CHILD HEALTH PLUS | OTHER | 59065 | 01 | NY | MAGNACARE | OTHER | AA50867 | 01 | NY | MDNY | OTHER |