Individual
JACQUELINE CARINNE MIRATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1650 HASLETT RD, HASLETT, MI 48840-7615
(517) 853-5588
(517) 853-5577
Mailing address
1650 HASLETT RD, HASLETT, MI 48840-7615
(517) 853-5588
(517) 853-5577
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5101018196
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316172992
—
MI
01
—
165330563
BCBS PIN
MI
Enumeration date
05/26/2009
Last updated
11/05/2013
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