Provider Demographics
NPI:1083840318
Name:HORVATH, MIA MELILLO (DPM)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:MELILLO
Last Name:HORVATH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:KATHERINE
Other - Last Name:MELILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1620 S STAPLEY DR STE 132
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6655
Mailing Address - Country:US
Mailing Address - Phone:480-834-8804
Mailing Address - Fax:
Practice Address - Street 1:1620 S STAPLEY DR STE 132
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6655
Practice Address - Country:US
Practice Address - Phone:480-834-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0750213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery