Organization
RODOLFO G MIRO MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE JORDAN (SECRETARY)
(863) 683-7561
Entity
Organization
Contact information
Practice address
2108 LAKELAND HILLS BLVD, LAKELAND, FL 33805-2906
(863) 683-7561
(863) 682-2423
Mailing address
2108 LAKELAND HILLS BLVD, LAKELAND, FL 33805-2906
(863) 683-7561
(863) 682-2423
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME16261
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53385
MEDICARE ID NUMBER
FL
Enumeration date
11/08/2010
Last updated
12/02/2010
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