Active NPI
Joseph Mirro Jr., MD
- Pediatric Hematology & Oncology Physician
- Kalamazoo, MI
National Provider Identifier
1427051200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Hematology & Oncology Physician
- License
- 13553
- Practice address
- 200 N Park St
West Michigan Cancer Center
Kalamazoo, MI 49007-3731 - Phone
- (269) 910-6555
- Fax
- (269) 384-8610
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Hematology & Oncology Physician | 2080P0207X | 13553 | TN | Primary |
| Pediatric Hematology & Oncology Physician | 2080P0207X | 4301100173 | MI |
Addresses
Primary practice location
200 N Park St
West Michigan Cancer Center
Kalamazoo, MI 49007-3731
Mailing address
200 N Park St
West Michigan Cancer Center
Kalamazoo, MI 49007-3731
Phone (269) 910-6555
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200179770A | Medicaid | IN | |
| 64712789 | Medicaid | KY | |
| 1534722 | Medicaid | LA | |
| 00118886 | Medicaid | MS | |
| 133070001 | Medicaid | AR | |
| 1427051200 | Medicaid | MI | |
| 1447261730 | Other | MI | BCBS - WMCC |
| Q13553 | Medicaid | SC | |
| 0528836 | Medicaid | IA | |
| 100025910A | Medicaid | OK | |
| 209684901 | Medicaid | MO | |
| 060495101 | Medicaid | TX | |
| 1135121 00 | Medicaid | WY | |
| 100249681-00 | Medicaid | NE | |
| 422400000 | Medicaid | ME | |
| 009914380 | Medicaid | AL | |
| 3821400 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13553 | TN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400457600000",
"number": "1427051200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 N PARK ST",
"address_2": "WEST MICHIGAN CANCER CENTER",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490073731",
"telephone_number": "269-910-6555",
"fax_number": "269-384-8610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 N PARK ST",
"address_2": "WEST MICHIGAN CANCER CENTER",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490073731",
"telephone_number": "269-910-6555",
"fax_number": "269-384-8610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRRO",
"first_name": "JOSEPH",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2014-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "TN",
"license": "13553",
"primary": true
},
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "MI",
"license": "4301100173",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200179770A",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64712789",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1534722",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00118886",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "133070001",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1427051200",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - WMCC",
"identifier": "1447261730",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q13553",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0528836",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100025910A",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209684901",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "060495101",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1135121 00",
"state": "WY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100249681-00",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "422400000",
"state": "ME"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009914380",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3821400",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.