Healthcare Provider Details

I. General information

NPI: 1770787053
Provider Name (Legal Business Name): SOMIA MIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 WATERMAN WAY
TAVARES FL
32778-5250
US

IV. Provider business mailing address

3330 WATERMAN WAY
TAVARES FL
32778-5250
US

V. Phone/Fax

Practice location:
  • Phone: 352-742-2192
  • Fax: 352-742-2689
Mailing address:
  • Phone: 352-742-2192
  • Fax: 352-742-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57004902
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37979
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number37979
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number37979
License Number StateIA
# 5
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME146431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: