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General NPI Number Information
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NPI Number | 1548671688
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Entity Type | Individual
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Provider Name | MILES S RAIZADA MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 1332 TEASLEY LN
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City | DENTON
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State | TX
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Zip | 76205-7946
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Country | US
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Telephone | 940-220-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 S 31ST ST MS-11-AG062
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City | TEMPLE
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State | TX
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Zip | 76508
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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 | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | Q6462
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | Q6462
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License Number State | TX
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