DR. Vasilisa Mironovich, M.D.

NPI #1295024479 in Portage, Wisconsin

Provider Information

NPI Number: 1295024479
Entity Type: Individual
Name: DR. Vasilisa Mironovich, M.D.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Family Medicine
Credential: M.D.
Enumeration Date: Mar 28, 2011
Last Updated: Sep 2, 2014

Practice Location

Address: 2817 NEW PINERY RD
City: Portage
State: Wisconsin
ZIP Code: 53901-9240
Phone: (608) 742-4131

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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