Healthcare Provider Details

I. General information

NPI: 1548671688
Provider Name (Legal Business Name): MILES S RAIZADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 TEASLEY LN
DENTON TX
76205-7946
US

IV. Provider business mailing address

2401 S 31ST ST MS-11-AG062
TEMPLE TX
76508
US

V. Phone/Fax

Practice location:
  • Phone: 940-220-8899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberQ6462
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ6462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: