Mitchell M Mirbaha, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

R3761 Issued in MO

Practice address

9815 Mackenzie Road
St Louis, MO 63123

Phone

(314) 638-8785

Fax

(314) 638-8788

NPI assigned

Nov 7, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• South St Louis Orthopedic Group Inc

  • Orthopaedic Surgery Physician
  • St Louis, MO
  • NPI 1831268663
  NPD (past) Authorized official
• Denise Hardy DPM Inc

  • Podiatrist
  • St Louis, MO
  • NPI 1467558379
  NPD (past)

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210550400000",
    "number": "1275602005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9815 MACKENZIE ROAD",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63123",
            "telephone_number": "314-638-8785",
            "fax_number": "314-638-8788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9815 MACKENZIE ROAD",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63123",
            "telephone_number": "314-638-8785",
            "fax_number": "314-638-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRBAHA",
        "first_name": "MITCHELL",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2008-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "R3761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20091403",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Christina Minzer, MD
• Kylie Grace Mirabella, BA
• Miracle Home Care II LLC
• Melanie Miranda Shukla
• Eugenia Hehner Miranti, MD
• Natalie Mirbaha
• Mona Mirkhaef, M.D.
• Katelin Anne Mirkin, M.D.
• Rhoderic Peter Mirkin, M.D.
• Jennifer Miros, MPT

• Orthopaedic Surgery Physician in St Louis, MO
• Providers in St Louis, MO by specialty
• Orthopaedic Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.