MEDICARE: ELIZABETH MILETI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	TC58002004	OH
2	2080P0206X	Pediatric Gastroenterology Physician	D01617	NV

General Provider Information

NPI Number	:	1194932145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MILETI DO

Provider Business Mailing Address
First Line	:	3196 S. MARYLAND PKWAY
Second Line	:	#309
City	:	LAS VEGAS
State	:	NV
Zip	:	89109
Country	:	US
Telephone Number	:	702-791-0477
Fax Number	:	702-791-6831

Provider Business Practice Location Address
First Line	:	3196 S. MARYLAND PKWAY
Second Line	:	#309
City	:	LAS VEGAS
State	:	NV
Zip	:	89109
Country	:	US
Telephone Number	:	702-791-0477
Fax Number	:	702-791-6831

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	11/01/2011

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