Individual
JOSEPH R MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3600 E HARRY ST, WICHITA, KS 67218-3713
(316) 689-5050
(316) 689-6192
Mailing address
PO BOX 645, WICHITA, KS 67201-0645
(316) 689-5050
(316) 689-6192
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22240
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018205
BCBS
KS
05
—
100141070C
—
KS
01
—
1209
PHS
KS
01
—
12149471
MULTIPLAN
KS
01
—
16908
COVENTRY
KS
01
—
200136
HPK
KS
Enumeration date
06/27/2006
Last updated
05/16/2014
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