Healthcare Provider Details

I. General information

NPI: 1083840318
Provider Name (Legal Business Name): MIA MELILLO HORVATH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIA KATHERINE MELILLO DPM

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 S STAPLEY DR STE 132
MESA AZ
85204-6655
US

IV. Provider business mailing address

1620 S STAPLEY DR STE 132
MESA AZ
85204-6655
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-8804
  • Fax:
Mailing address:
  • Phone: 480-834-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0750
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: