Provider Demographics
NPI:1215114889
Name:MIGLIORE, KRISTA IRGENS (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:IRGENS
Last Name:MIGLIORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 NW WASHINGTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6381
Mailing Address - Country:US
Mailing Address - Phone:513-867-5770
Mailing Address - Fax:513-737-2468
Practice Address - Street 1:840 NW WASHINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6384
Practice Address - Country:US
Practice Address - Phone:513-867-4165
Practice Address - Fax:513-867-4168
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-26
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34010587207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067214Medicaid
OH0067214Medicaid