Provider Demographics
NPI:1427051200
Name:MIRRO, JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MIRRO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N PARK ST
Mailing Address - Street 2:WEST MICHIGAN CANCER CENTER
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3731
Mailing Address - Country:US
Mailing Address - Phone:269-910-6555
Mailing Address - Fax:269-384-8610
Practice Address - Street 1:200 N PARK ST
Practice Address - Street 2:WEST MICHIGAN CANCER CENTER
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3731
Practice Address - Country:US
Practice Address - Phone:269-910-6555
Practice Address - Fax:269-384-8610
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN135532080P0207X
MI43011001732080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200179770AMedicaid
KY64712789Medicaid
LA1534722Medicaid
MS00118886Medicaid
AR133070001Medicaid
MI1427051200Medicaid
MI1447261730OtherBCBS - WMCC
SCQ13553Medicaid
IA0528836Medicaid
OK100025910AMedicaid
MO209684901Medicaid
TX060495101Medicaid
WY1135121 00Medicaid
NE100249681-00Medicaid
ME422400000Medicaid
AL009914380Medicaid
TN3821400Medicaid
WY1135121 00Medicaid
KY64712789Medicaid
TN3821405Medicare ID - Type UnspecifiedMEDICARE
ME422400000Medicaid