Healthcare Provider Details

I. General information

NPI: 1265501340
Provider Name (Legal Business Name): JOHN R MIELE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE SUITE 102
JOHNSTON RI
02919
US

IV. Provider business mailing address

1539 ATWOOD AVE SUITE 102
JOHNSTON RI
02919
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-4701
  • Fax: 401-454-4451
Mailing address:
  • Phone: 401-751-4701
  • Fax: 401-454-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM00242
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: