Provider Demographics
NPI:1073555207
Name:MIELE, GERALD B (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:B
Last Name:MIELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 E CHEVES ST
Mailing Address - Street 2:P. O. BOX 1905
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29503-1905
Mailing Address - Country:US
Mailing Address - Phone:843-413-3100
Mailing Address - Fax:843-413-3197
Practice Address - Street 1:506 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2616
Practice Address - Country:US
Practice Address - Phone:843-413-3100
Practice Address - Fax:843-413-3197
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18704207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890644KMedicaid
SCT28994Medicaid
NC890644KMedicaid