Individual
RUEL T MICIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
702 THUNDERBIRD DR, HARRISONVILLE, MO 64701-1558
(816) 380-4040
Mailing address
702 THUNDERBIRD DR, HARRISONVILLE, MO 64701-1558
(816) 380-4040
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33300
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01249031
BCBS
—
05
—
599764206
—
MO
Enumeration date
10/05/2005
Last updated
02/24/2015
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