Carlos J Miro, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4641-015 Issued in WI

Practice address

4536 22ND Ave
Kenosha, WI 53140-5917

Phone

(262) 656-0044

Fax

(262) 653-2218

NPI assigned

Nov 15, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Scenic Bluffs Health Center, Inc

  • Dental Clinic/Center
  • Cashton, WI
  • NPI 1124270178
  NPD (past)

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1386626554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 S 57TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532143333",
            "telephone_number": "414-302-9468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4536 22ND AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531405917",
            "telephone_number": "262-656-0044",
            "fax_number": "262-653-2218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRO",
        "first_name": "CARLOS",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4641-015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33725700",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "address_1": "4536 22nd Ave",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531405917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Miso Niko Miloslavic, MD
• Mindful Balance Integrated Weight Loss and Wellness
• Trista Ann Minezes, RN
• Scott D Mingilino, FNP-BC, PMHNP-BC
• Jamie Rae Mings, M.D.
• Shazia Mirza, M.D.
• Rebecca Misanin, PT, DPT
• Jasmine Mitchell
• Lisa Marie Mlodzik, PHARM D, CGP, FASCP
• MMS

• General Practice Dentistry in Kenosha, WI
• Providers in Kenosha, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.