Basic Information
| Provider Information | |||||||||
| NPI: | 1083667265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIRECKI | ||||||||
| FirstName: | FRANCIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 164 OTROBANDO AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608860023 | ||||||||
| FaxNumber: | 8608860024 | ||||||||
| Practice Location | |||||||||
| Address1: | 164 OTROBANDO AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608860023 | ||||||||
| FaxNumber: | 8608860024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 11/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 33689 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 010033689CT05 | 01 | ANTHEM/ECCD:06-1616101 | OTHER | 033689 | 01 | CONNECTICARE | OTHER | 001336892 | 01 | BLUECARE FAMILY PLAN | OTHER | 110088356 | 01 | RR MED/ECCG: 06-1049086 | OTHER | 030514 | 01 | HEALTHNET/ECCG:06-1049086 | OTHER | 0V9737 | 01 | HEALTHNET/ECCD:06-1616101 | OTHER | NLS105 | 01 | OXFORD/ECCG: 06-1049086 | OTHER | 001336892 | 05 | CT | MEDICAID | 010033689CT01 | 01 | ANTHEM/ECCG:06-1049086 | OTHER | 060064827 | 01 | RR MED/ECCD: 06-1616101 | OTHER | 500HBC444CT01 | 01 | ANTHEM/HOSP-BASED ECCD | OTHER | P2524312 | 01 | OXFORD/ECCD: 06-1616101 | OTHER |