MEDICARE: MIA ADDISON DUNCAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	35.090191	OH
2	208800000X	Urology Physician	ML20007145	WA
3	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	MD60082415	WA
4	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	35.090191	OH

General Provider Information

NPI Number	:	1134239262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA ADDISON DUNCAN MD

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 E DUBLIN GRANVILLE RD STE 220
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-8701
Country	:	US
Telephone Number	:	614-788-2870
Fax Number	:	614-533-0177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/03/2023

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