Provider Demographics
NPI:1073994141
Name:BELL, MIA (DO)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:BLACCONIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3401 N MIAMI AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3546
Mailing Address - Country:US
Mailing Address - Phone:305-209-1920
Mailing Address - Fax:
Practice Address - Street 1:3401 N MIAMI AVE STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3546
Practice Address - Country:US
Practice Address - Phone:305-209-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361450922084P0804X
FL168492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1073994141Medicaid