Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mario Miranda, DO

Individual provider Family Medicine Physician · NPI 1376505420

Mario Miranda, DO is an Emergency Medicine in Peoria, Illinois. Qualified in 1995, 31 years ago. Practices with Concord Company of Tennessee PLLC, a 67-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
31
Licensed in
IL
In the registry since
2006
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

221 NE Glen Oak Ave
Peoria, IL 61603-4307
Phone: (309) 672-5522
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X (IL)
Family Medicine Physician Taxonomy 207Q00000X (IL)

Record details

NPI number1376505420
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 4, 2006
Last updated in NPPESFebruary 5, 2008
Mailing address21276 Network Pl, Chicago, IL 60673-1212

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolOTHER
Graduated 1995 (31 years in practice)
Group practice Concord Company Of Tennessee Pllc — 67 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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