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Individual
NANA MIMURA
Active
Individual
NANA MIMURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301065734
MI
207R00000X
Internal Medicine Physician
Primary
ME111706
FL
208M00000X
Hospitalist Physician
ME111706
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1105009572
BCBSMI PERSONAL PIN
MA
01
—
110E011830
SCHOENHERR BCBS GR PIN
MI
01
—
200158731
WARREN TAX ID
MI
01
—
381898230
SCHOENHERR TAX ID
MI
05
—
4216940
—
MI
05
—
4749053
—
MI
01
—
700E001650
WARREN BCBS GR PIN
MI
01
—
ME111706
FLORIDA MEDICAL LICENSE
FL
Enumeration date
09/25/2006
Last updated
05/24/2016
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