Healthcare Provider Details

I. General information

NPI: 1326323056
Provider Name (Legal Business Name): MIWA MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 DIVISION AVE STE G
SAN ANTONIO TX
78214-1336
US

IV. Provider business mailing address

PO BOX 6818
SAN ANTONIO TX
78209-0818
US

V. Phone/Fax

Practice location:
  • Phone: 210-259-8088
  • Fax: 210-265-1142
Mailing address:
  • Phone: 830-309-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN7147
License Number StateTX

VIII. Authorized Official

Name: DR. EDWARD A MIWA
Title or Position: OWNER
Credential: M.D
Phone: 210-391-8400