Individual
ERNESTO BOGARIN MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1520 MADISON AVE, FORT ATKINSON, WI 53538-3100
(920) 563-5500
Mailing address
1520 MADISON AVE, FORT ATKINSON, WI 53538-3100
(920) 563-5500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
73153-20
WI
207Q00000X
Family Medicine Physician
RL14696
ND
207R00000X
Internal Medicine Physician
R74574
AZ
Other
Enumeration date
07/25/2014
Last updated
10/07/2022
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