MEDICARE: MIA EIDE RDN

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	133V00000X	Registered Dietitian	86418972	AZ

General Provider Information

NPI Number	:	1891653614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA EIDE RDN

Provider Business Mailing Address
First Line	:	1301 N SCOTTSDALE RD APT 1053
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-3457
Country	:	US
Telephone Number	:	320-212-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	6124 E BROWN RD STE 102
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-4959
Country	:	US
Telephone Number	:	480-809-6513
Fax Number	:	480-809-6823

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ MIA EIDE RDN” Practice Location

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