Provider Demographics
NPI:1174625784
Name:MIRO, ZENOBIA (MD)
Entity type:Individual
Prefix:DR
First Name:ZENOBIA
Middle Name:
Last Name:MIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N. UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-962-4680
Mailing Address - Fax:954-966-6927
Practice Address - Street 1:2301 N. UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-962-4680
Practice Address - Fax:954-966-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263363900Medicaid
FLH63633Medicare UPIN
FL58787Medicare PIN