Healthcare Provider Details

I. General information

NPI: 1306738679
Provider Name (Legal Business Name): WINSTON MIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 07/19/2025
Certification Date: 07/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6835 BROADWAY AVE
CLEVELAND OH
44105-1313
US

IV. Provider business mailing address

2461 W 25TH ST UNIT 533
CLEVELAND OH
44113-5608
US

V. Phone/Fax

Practice location:
  • Phone: 216-957-1500
  • Fax:
Mailing address:
  • Phone: 216-338-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QP0002X
TaxonomyPhysician Nutrition Specialist (Family Medicine)
License Number57.257906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: