MEDICARE: MILEY DIEM LE

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	2255A2300X	Athletic Trainer	K03-15-9576	KS

General Provider Information

NPI Number	:	1467127043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILEY DIEM LE

Provider Business Mailing Address
First Line	:	1841 N ROCK ROAD CT STE 300
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-4212
Country	:	US
Telephone Number	:	316-239-1229
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 N ROCK ROAD CT STE 300
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-4212
Country	:	US
Telephone Number	:	316-239-1229
Fax Number	:

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

Provider Enumeration Date	:	08/15/2021
Last Update Date	:	08/15/2021

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Directions to “ MILEY DIEM LE ” Practice Location

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