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NPI Code Detail

MEDICARE: DR. MICHAEL CHARLES MIELLO M.D.

MEDICARE: DR. MICHAEL CHARLES MIELLO 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
12080P0204XPediatric Emergency Medicine (Pediatrics) Physician024605GA

General Provider Information

NPI Number : 1588725360
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL CHARLES MIELLO M.D.
Provider Business Mailing Address
First Line : 1645 TULLIE CIR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2304
Country : US
Telephone Number : 404-785-7141
Fax Number :
Provider Business Practice Location Address
First Line : 1645 TULLIE CIR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2304
Country : US
Telephone Number : 404-785-7141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 07/08/2007

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