| Doctor Name: | DR. BRIAN MICHAEL MIRACLE |
| NPI Number: | 1992860837 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPT, OCS |
| License Number: | |
| Business Practice Address: | Raf Lakenheath 48 Mdg/sgoy Unit 5210 Box 230 Apo, AE - 094640230 |
| Business Phone Number: | 3122268124 |
| Business Fax Number: | |
| Mailing Address: | Raf Lakenheath 48 Mdg/sgoy, Unit 5210 Box 230 APO |
| State: | AE |
| Postal Code: | 094640230 |
| Phone Number: | 3122268124 |
| Fax Number: | |
| NPI Enumeration Date: | 12/22/2006 |
| NPI Last Update Date: | 07/31/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |