Healthcare Provider Details

I. General information

NPI: 1992091755
Provider Name (Legal Business Name): MELISSA MARIE MILES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SHADOW LN STE 370
LAS VEGAS NV
89106-4159
US

IV. Provider business mailing address

700 SHADOW LN STE 370
LAS VEGAS NV
89106-4159
US

V. Phone/Fax

Practice location:
  • Phone: 702-693-6870
  • Fax: 702-693-6899
Mailing address:
  • Phone: 702-693-6870
  • Fax: 702-693-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number17221
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT198821
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: