Provider Demographics
NPI:1093799256
Name:REDLEAF, MIRIAM I (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:I
Last Name:REDLEAF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2719
Mailing Address - Country:US
Mailing Address - Phone:505-272-6487
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:2211 LOMAS BLVD NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-8710
Practice Address - Country:US
Practice Address - Phone:505-272-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-086121207Y00000X, 207YX0905X
NMMD202-0911207YX0901X
NMMD2020-0911207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE29303Medicare UPIN
ILL63936/357801Medicare ID - Type Unspecified