Provider Demographics
NPI:1104934017
Name:LUGO-MIRO, VICTOR IVAN (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:IVAN
Last Name:LUGO-MIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:I
Other - Last Name:LUGO-MIRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:3036 NORTHPARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-360-8501
Mailing Address - Fax:281-360-8617
Practice Address - Street 1:3036 NORTHPARK DRIVE
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-360-8501
Practice Address - Fax:281-360-8617
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6890207Q00000X, 208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080241501Medicaid
TX080241501Medicaid
E42594Medicare UPIN