Individual provider Active NPI

Natalie Rose Mironov, DO

  • Obstetrics & Gynecology Physician
  • Milwaukee, WI
National Provider Identifier
1225659816
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
81469-21 Issued in WI
Practice address
9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone
(414) 805-4777
Fax
(414) 805-4774
NPI assigned
May 5, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 5151014272 MI
Obstetrics & Gynecology Physician 207V00000X 81469-21 WI Primary

Addresses

Primary practice location

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522

Mailing address

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 805-4777

Other identifiers 1

IdentifierTypeStateIssuer
1225659816MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240911001962 WI Practitioner - Obstetrics/Gynecology 5294156329 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Medical College of Wisconsin IncGroup PAC ID 2668384371, 2,092 clinicians

Practice addresses (Care Compare)

11211 W Lincoln Ave
West Allis, WI 53227-1035
Phone (414) 454-8300

1155 N Mayfair Rd
Wauwatosa, WI 53226-3462
Phone (414) 955-5990

8701 W Watertown Plank
Milwaukee, WI 53226-3548
Phone (414) 805-3666

8701 Watertown Plank Rd
Room 4041 MFRC
Milwaukee, WI 53226-3548
Phone (414) 805-3666

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
81469-21WIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 1, 2024 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Sep 1, 2024 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 1, 2024 Accepting new patients
The Medical College of Wisconsin Inc Past Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

11211 W Lincoln Ave
West Allis, WI 53227
Phone (414) 454-8300

Interoperability endpoints

  • Direct secure messaging: nmironov827521@direct.froedtert.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1225659816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-4777",
            "fax_number": "414-805-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-4777",
            "fax_number": "414-805-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRONOV",
        "first_name": "NATALIE",
        "middle_name": "ROSE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-05",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5151014272",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "81469-21",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225659816",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.