Look up the most recent NPI and PECOS records

Kristian Rafael Henriquez Mirandona

Internal Medicine

Allopathic & Osteopathic Physicians

11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701

PECOS Enrollment

This provider is enrolled in PECOS as KRISTIAN HENRIQUEZ MIRANDONA.

Based on the most recent information from CMS, provider Kristian Rafael Henriquez Mirandona is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1245671585
Provider Type
Individual
Full Name
Henriquez Mirandona, Kristian Rafael
Credential
M.D

Gender
Male
Sole Proprietor
Yes
Enumeration Date
7/15/2013
Last Updated
12/2/2024

Contact Information

Practice Location

11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701

(260) 672-6620

(260) 672-6639

Mailing Location

11109 Parkview Plaza Dr # 117, Fort Wayne, IN 46845-1701

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 01080797A Indiana

Kristian Rafael Henriquez Mirandona

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Sorg, Kelli A

Wertz, Emily

Dhungana, Prabij

Blum, Corey M

Gauchan, Shiva

Aryal, Sarthak

Laughlin, Jenna Leigh

Naing, Nyi T

Singh, Gopesh K

Dilag, Rene Francis Carreon