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General NPI Number Information
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NPI Number | 1326323056
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Entity Type | Organization
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Legal Business Name | MIWA MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 600 DIVISION AVE STE G
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City | SAN ANTONIO
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State | TX
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Zip | 78214-1336
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Country | US
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Telephone | 210-259-8088
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Fax | 210-265-1142
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Provider Business Mailing Address
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Address Line | PO BOX 6818
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City | SAN ANTONIO
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State | TX
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Zip | 78209-0818
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Country | US
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Telephone | 830-309-8621
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD A MIWA
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Credential | M.D
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Telephone | 210-391-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N7147
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License Number State | TX
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