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NPI Code Detail

MEDICARE: DR. GREG M MIELKE M.D.

MEDICARE:  DR. GREG M MIELKE  M.D.
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
1174400000XSpecialist01034860AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366484099
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREG M MIELKE M.D.
Provider Business Mailing Address
First Line : 3926 NEW VISION DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1712
Country : US
Telephone Number : 260-266-8210
Fax Number : 260-458-5636
Provider Business Practice Location Address
First Line : 1111 LIGHTHOUSE LN
Second Line :
City : GOSHEN
State : IN
Zip : 46526-3824
Country : US
Telephone Number : 574-533-0348
Fax Number : 574-533-0277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 10/05/2016

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Directions to “ DR. GREG M MIELKE M.D.” Practice Location

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