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General NPI Number Information
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NPI Number | 1265425532
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Entity Type | Individual
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Provider Name | BRENDAN A MIELKE MD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 700 W IRONWOOD DR STE 375
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4401
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Country | US
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Telephone | 208-625-6100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3649
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City | SPOKANE
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State | WA
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Zip | 99220-3649
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | M-8328
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD00040221
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License Number State | WA
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