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Organization
MEMORIAL LIGHTHOUSE IMAGING LLC
Active
Organization
MEMORIAL LIGHTHOUSE IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEDRO A MIRO MD (MANAGER)
(574) 258-1100
Entity
Organization
Contact information
Practice address
919 E JEFFERSON BLVD, SOUTH BEND, IN 46617-3112
(574) 288-4486
(574) 258-1101
Mailing address
620 W EDISON RD, SUITE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
Primary
—
—
Other
Enumeration date
01/29/2007
Last updated
09/11/2025
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